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Objective To evaluate the clinical effectiveness and safety of percutaneous transhepatic papillary balloon dilatation (PTBD) combined with laparoscopic cholecystectomy (LC) for concurrent gallstones and common bile duct stones.Methods From Sep 2010 to Dec 2016,23 patients undergoing PTBD + LC were retrospectively compared with 34 cases recieving laparascopic common bile duct exploration (LCBDE) + LC.Parameters included surgical success rate,postoperative complications,residual stone rate,operation time,postoperative anal exhaust time,postoperative hospital stay,and hospitalization expenses.Results In this study 23 patients received PTBD + LC,34 patients received LCBDE + LC.In PTBD + LC group:the operation success rate was 91.3％,postoperative complications (2 cases of pancreatitis,3 cases of pulmonary infection,1 case of incisional infection),and the postoperative residual stone rate was 4.3％.In LCBDE + LC group:surgery success rate was 88.2％,postoperative complications (bile leakage 2 cases,lung infection 2 cases,incisional infection 1 case),postoperative residual stone found in 2.9％;The success rate,postoperative complications and postoperative residual stone rate between the two groups were not statistically different (P ＞ 0.05),nor in operation time,postoperative anal exhaust time,and hospitalization cost (P ＞ 0.05).PTBD + LC group had shorter hospital stay (P ＜ 0.05).Conclusions PTBD combined with LC is effective and safe procedure for the treatment of gallstones and bile duct stones.
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Objective To compare the clinical results between laparoscopic assisted small incision biliary duct exploration with traditional biliary exploration for patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times.Methods The clinical data of patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times,and underwent laparoscopic assisted small incision biliary duct exploration or traditional biliary exploration from September 2011 to June 2016 were retrospectively studied.Results 23 patients underwent laparoscopic assisted small incision biliary duct exploration (Group A),and 24 patients underwent traditional biliary exploration (Group B).The time spent on abdominal adhesion separation in group A and group B was (74.7 ± 20.5) min and (90.8 ± 20.3) min (P ＜ 0.05),respectively.The amount of intraoperative blood loss were (67.4 ± 35.6)ml and (107.4±31.5) ml (P ＜0.05).The number of patients with intestinal injury were 0 and 4.The postoperative time to first pass flatus was (26.9 ± 3.8) h and (35.5 ± 6.5) h (P ＜ 0.05).The durations of postoperative hospital stay were (8.1 ± 1.4) d and (12.8 ± 2.9) d,respectively,(P ＜ 0.05).The numbers of patients who required postoperative analgesics were 10 and 19 cases (P ＜ 0.05).The number of patients with postoperative incisional wound infection were 1 and 6.There was no significant difference in the time spent on biliary exploration,incidences of biliary leakage,pulmonary infection rate,hospitalization cost and liver function status between the two groups of patients (P ＞ 0.05).Conclusions Laparoscopic assisted small incision biliary duct exploration was safe and effective for patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times.This operation can be used as a preferred procedure.
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Objective To study the use of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with cholecystocholedocholithiasis.Methods From July 2006 to June 2010,127 patients with cholecystocholedocholithiasis were treated either by LC+LCBDE (n=78) or LC+endoscopic sphincterotomy (EST,n=49).The treatment success rate,complications,retained bile duct stones rate,recovery of gastrointestinal function and hospital-stay were retrospectively analyzed.Results The LCBDE+ LC group:The operative success rate was 94.87 ％.The incidence of postoperative complications was 5.41 ％.The EST+ LC group:Complete removal of bile duct stones was achieved in 46 of 48 patients (95.92％).The incidence of postoperative complications was 12.77％.There was a significant difference in the incidences of postoperative complications between the EST+ LC group and the LCBDE+ LC group (P＜0.05).The operative time and the cost for hospital stay between the two groups were significantly different (P＜0.05).After a follow-up of 3.2 years (mean,range 1-5 years),there was no significant difference in long-term complications such as bile duct recurrent stones,duodenal papilla stenosis and cholangitis between the two groups (P＜0.05).ConclusionsLCBDE was a safe,efficacious and feasible minimal invasiveness treatment for cholecystocholedocholithiasis.Primary closure of common bile duct in selected cases brought additional benefits to the minimal invasive technique.
