Résumé
Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with primary suture (PS) versus two-stage endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis.Methods The clinical data of 171 patients with cholecystolithiasis complicated with choledocholithiasis,who underwent minimally invasive surgical treatment from January 2016 to December 2017,were retrospectively analyzed.Of these patients,90 underwent one-stage LC + LCBDE + PS (the one-stage group),and 81 underwent two-stage ERCP/EST followed by LC (the two-stage group).The main clinical variables between the two groups of patients were compared.Results The surgical success rates (94.4％ vs.95.1％),residual stone rates (3.3％ vs.4.9％) and incidences of postoperative complications (6.7％ vs.8.6％) showed no significant difference (all P ＞ 0.05) between the one-stage and two-stage groups.Compared with the two-stage group,the operative time was shorter (110.4 vs.135.7 min),the length of postoperative hospital stay was shorter (3.3 vs.7.1 d) and the total hospitalization cost was reduced (22 756.2 vs.31 429.3 yuan) in the one-stage group.The incidence of long-term complications (2.2％ vs.9.9％) in the one-stage group was also lower than that in the two-stage group (both P ＜ 0.05).Condusions Both one-stage LC + LCBDE + PS and two-stage ERCP/EST + LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis.One-stage LC + LCBDE + PS shows obvious advantages in hospitalization stay,hospitalization cost and in the preservation of function of the Oddi sphincter,and therefore should be the first choice in most cases.
Résumé
Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with primary suture (PS) and two-staged endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Of these patients,58 received one-staged LC + LCBDE + PS (the one-stage group),and 71 underwent two-staged ERCP/EST followed by LC (the two-stage group).Results The surgical success rate,residual stone rate,incidence of postoperative complications and operative time showed no significant difference (x2 =0.344,0.344,0.108,t =-0.240,all P ＞ 0.05) in both the one-staged and two-stage groups.Compared with the two-staged group,the hospital stay was shorter (4.1d vs.6.9d) and the total hospitalization cost was lower (23 126 yuan vs.32 982 yuan) in the one-staged group.Conclusion Both one-staged LC + LCBDE + PS and two-staged ERCP/EST + LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis on base for base basis.
Résumé
Objective To study the feasibility and efficacy of treatment of extrahepatic cholangiolithiasis using laparoscopic self-releasing J-tube drainage combined with primary suturing of common bile duct.Methods The clinical data of 172 patients with extrahepatic cholangiolithiasis who underwent operations from March 2013 to January 2015 were retrospectively studied.The patients were divided into two groups:the J-tube drainage group (n =82) and the T-tube drainage group (n =90).Surgical duration,intraoperative bleeding,postoperative hospital stay,treatment cycles,hospital costs,incidences of postoperative bile leakage and residual extrahepatic cholangiolithiasis were compared between the two groups.Results The length of postoperative hospital stay in the J-tube drainage group was (4.9 ± 1.2) days and in the T-tube drainage group was (8.0 ± 2.0) days.The treatment cycles in the J-tube drainage group were (4.9 ± 1.2) days while in the T-tube drainage group were (24.1 ± 3.2) days.The hospital costs in the J-tube drainage group were (12 817.1 ±3 167.1) yuan and the costs in the T-tube drainage group were (15 012.5 ±2 354.8) yuan.There were significant differences in hospital stay,treatment cycles and hospital costs between the two groups (all P ＜ 0.05).The surgical duration in the J-tube drainage group was (108.2 ± 10.2) minutes and the duration in the T-tube drainage group was (110.1 ± 13.1) minutes.The amount of intraoperative bleeding in the J-tube drainage group was (35.0 ± 20.0) ml and the amount in the T-tube drainage group was (42.0 ±30.0) ml.There were no significant differences in intraoperative bleeding and surgical duration between the two groups (all P ＞ 0.05).No significant differences were observed in the incidences of post-operative bile leakage and in residual extrahepatic cholangiolithiasis between the two groups (P ＞ 0.05).Conclusions Self-releasing J-tube drainage combined with laparoscopic primary suturing of common bile duct was safe and efficacious.It was minimally invasive in treating patients with extrahepatic cholangiolithiasis.