Comparison of laparoscopic papillary dilation and Endoscopic sphincterotomy with small incision treating fine stones in common bile duct with stricture of oddi sphincter / 中国内镜杂志

ABSTRACT

Objective Analyze and compare the clinical data of patients with choledocholithiasis combined with benign biliary stricture and Oddi sphincter received laparoscopic percutaneous endoscopic dilation of duodenal papilla and endoscopic sphincterotomy, to explore the clinical experience and investigate the safety and superiority of laparoscopic papillary dilatation and the clinical value in extending the first phase suturing.. Methods From January 2016 to January 2017, 60 patients with choledocholithiasis combined with Oddi sphincter received laparoscopic nipple expansion (30 cases, Group L) and the others received endoscopic sphincterotomy (30 cases, Group E). All the patients clinical data was retrospectively compared and analyzed to explore the clinical experience. Results All operation were successfully performed with no perioperative deaths occurred.. By comparison of the clinical data before and after surgery, we learned that the changes of alanine aminotransferase (ALT), aspartate transaminase (AST), direct bilirubin and postoperative biliary tract bleeding has no statistically significant difference (P > 0.05), while the operation time, the changes of blood amylase and lipase, postoperative gastrointestinal symptoms, postoperative pancreatitis, gastrointestinal function recovery time has statistically significant differences (P < 0.05). There has one self-healing bile leakage case in Group L thanks to routine placement of abdominal drainage tube intraoperatively. The patients gastrointestinal function recovered quick and not suffered pancreatitis because of there's no incision of nipple sphincter. Conclusion Laparoscopic papillary dilation reflects its superiority for not increase postoperative liver function damage, DBIL abnormalities, residual stones, biliary tract bleeding and biliary stricture, while can effectively decrease the incidence of complications such as postoperative pancreatitis, bile reflux and gastrointestinal symptoms. It is safe and effective with less postoperative complications in appropriately application in treatment of fine diameter common bile duct stones with sphincter of Oddi stenosis.