Strategy of laparoscopy and choledochoscopy or duodenoscopy for the treatment of cholecystolithiasis combined with choledocholithiasis / 中华消化外科杂志

ABSTRACT

Cholecystolithiasis combined with choledocholithiasis is a common disease.The typical open surgery is challenged by the minimally invasive surgery recently.The minimally invasive surgery combined with laparoscopy and choledochoscopy or duodenoscopy has been accepted widely through analyzing and summarizing comprehensively the current situation of the minimally invasive surgery for cholecystolithiasis combined with choledocholithiasis.Laparoscopic cholecystectomy (LC) +endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) should be chosen primarily for the patients with cholecystolithiasis combined with choledocholithiasis and without common bile duct dilatation (common bile duct diameter ＜0.8 cm),and LC + laparoscopic transcystic common bile duct exploration and lithotomy are used under favorable conditions.LC + choledocholithotomy or T tube drainage should be chosen primarily for the patients with cholecystolithiasis combined with choledocholithiasis and common bile duct dilatation (common bile duct diameter ＞ 0.8 cm).Primary suture of common bile duct should be used with removal of the common bile duct stones,patency of distal common bile duct and recovery function of sphincter of Oddi.The minimally invasive surgery combined with laparoscopy and choledochoscopy or duodenoscopy which is selected reasonably could improve the treatment of cholecystolithiasis combined with choledocholithiasis and reduce the complications,with a significant clinical efficacy.