中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 4
Apr.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(4): 872-876

Clinical effect of laparoscopy, choledochoscopy, and duodenoscopy combined with T-tube-free drainage in treatment of gallstones with common bile duct stones

DOI: 10.3969/j.issn.1001-5256.2021.04.029

  • Department of General Surgery, Pudong New Area People's Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201200, China

  • Received Date: 2020-10-07
  • Accepted Date: 2020-11-09
  • Published Date: 2021-04-20
    Abstract
  •   Objective  To investigate the clinical effect of laparoscopy, choledochoscopy, and duodenoscopy combined with T-tube-free drainage in the treatment of gallstones with common bile duct stones.  Methods  A retrospective analysis was performed for the clinical data of 564 patients with gallstones and common bile duct stones who were admitted to Department of General Surgery, Pudong New Area People's Hospital, Shanghai University of Medicine & Health Sciences, from December 2017 to December 2019. According to the surgical procedure, the patients were divided into laparoscopic transcystic common bile duct exploration (LTCBDE) group with 191 patients, three endoscopies+laparoscopic common bile duct exploration and primary suture (LBEPS) group with 138 patients, and endoscopic retrograde cholangiopancreatography (ERCP)+endoscopic sphincterotomy (EST)/endoscopic papillary balloon dilation (EPBD)+laparoscopic cholecystectomy (LC) group with 235 patients. The three groups were analyzed in terms of the general data including sex, age, bile duct diameter, and stone size/number, and surgical condition and complications were compared between groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.  Results  There were significant differences between the LBEPS group, the ERCP+EST/EPBD+LC group and the LTCBDE group in hospital costs, drainage volume, time to first flatus, length of hospital stay and time to extraction of drainage tube (F=416.40, 7.80, 33.99, 143.70, and 13.08, P < 0.001, P=0.020, P < 0.001, P < 0.001, and P < 0.001). Compared with the LBEPS group and ERCP+EST/EPBD+LC groups, the LTCBDE group had significantly lower hospital costs and a significantly longer time to first flatus, and significantly shorter length of hospital stay and time to extraction of drainage tube(all P < 0.05). No serious complication was observed after surgery, and there was no significant difference in the incidence rate of complications between the three groups (P>0.05). All patients were discharged successfully after surgery.  Conclusion  The three minimally invasive surgical procedures combined with T-tube-free drainage achieve the goal of little trauma and pain, fast postoperative recovery, and few serious complications, among which LTCBDE has the lowest treatment costs and the best postoperative recovery.

     

    • FullText(HTML)
  • loading
    • References(16)
  • [1]
    LIU XJ, HE XZ. Clinical analysis of residual choledocholithiasis after laparoscopic cholecystectomy[J]. J Hepatopancreatobiliary Surg, 2019, 31(9): 566-568. DOI: 10.11952/j.issn.1007-1954.2019.09.013.

    刘小健, 何信众. 腹腔镜胆囊切除术后胆总管残留结石的临床分析[J]. 肝胆胰外科杂志, 2019, 31(9): 566-568. DOI: 10.11952/j.issn.1007-1954.2019.09.013.
    [2]
    PAN L, CHEN M, JI L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: An up-to-date Meta-analysis[J]. Ann Surg, 2018, 268(2): 247-253. DOI: 10.1097/SLA.0000000000002731.
    [3]
    AHN DW, LEE SH, PAIK WH, et al. Effects of saline irrigation of the bile duct to reduce the rate of residual common bile duct stones: A multicenter, prospective, randomized study[J]. Am J Gastroenterol, 2018, 113(4): 548-555. DOI: 10.1038/ajg.2018.21.
    [4]
    SUN XD, QIU W, LYU GY, et al. Clinical efficacy of combined three-endoscopic minimally invasive surgical treatment of extrahepatic cholangiolithiasis in 2364 patient[J]. Chin J Dig Surg, 2016, 15(4): 357-362. DOI: 10.3760/cma.j.issn.1673-9752.2016.04.010.

    孙晓东, 邱伟, 吕国悦, 等. 2364例肝外胆管结石三镜联合微创外科治疗的临床疗效[J]. 中华消化外科杂志, 2016, 15(4): 357-362. DOI: 10.3760/cma.j.issn.1673-9752.2016.04.010.
    [5]
    ZHANG LH, TAO LD, ZENG J, et al. Combined treatment of choledocholithiasis with cholecystolithiasis Oddi sphincter function[J]. Chin J Gen Surg, 2019, 34(11): 994-995. DOI: 10.3670.cma.j.issn.1007-631X.2019.11.025.

    张立洪, 陶立德, 曾佳, 等. 保护Oddi括约肌功能的三镜联合治疗胆总管结石合并胆囊结石[J]. 中华普通外科杂志, 2019, 34(11): 994-995. DOI: 10.3670.cma.j.issn.1007-631X.2019.11.025.
    [6]
    WANG AQ, YI SN, LIU JH. Application of three-mirror combined with transabdominal drainage of nasal bile duct in elderly patients with extrahepatic cholelithiasis[J]. J Hepatopancreatobiliary Surg, 2018, 30(6): 485-488. DOI: 10.11952/j.issn.1007-1954.2018.06.010.

    王安琪, 尹思能, 刘进衡. 三镜联合经腹置入鼻胆管引流在老年肝外胆管结石中的应用[J]. 肝胆胰外科杂志, 2018, 30(6): 485-488. DOI: 10.11952/j.issn.1007-1954.2018.06.010.
    [7]
    WANG YF, WANG AL, LI Z, et al. Laparoscopic transcystic common bile duct exploration and laparoscopic transductal common bile duct exploration in elderly patients with cholecystolithiasis combined with choledocholithiasis[J]. Chin Med J (Engl), 2019, 132(14): 1745-1746. DOI: 10.1097/CM9.0000000000000323.
    [8]
    CZERWONKO ME, PEKOLJ J, UAD P, et al. Laparoscopic transcystic common bile duct exploration in the emergency is as effective and safe as in elective setting[J]. J Gastrointest Surg, 2019, 23(9): 1848-1855. DOI: 10.1007/s11605-018-4029-x.
    [9]
    ZHU JG, WU S, FENG Q, et al. Protocol for the CREST Choles (Chinese REgistry Study on Treatment of Cholecysto-Choledocholithiasis) study: An ambispective, multicenter, observational, open-cohort study[J]. BMJ Open, 2019, 9(11): e030293. DOI: 10.1136/bmjopen-2019-030293.
    [10]
    FU Y, KONG J, WANG D, et al. Cholelithiasis and choledocholithiasis in a 78-day-old infant suffering from jaundice, and treated through laparoscopic transcystic common bile duct exploration (LTCBDE)[J]. Asian J Surg, 2019, 42(10): 930-931. DOI: 10.1016/j.asjsur.2019.05.013.
    [11]
    PANG L, ZHANG Y, WANG Y, et al. Transcystic versus traditional laparoscopic common bile duct exploration: Its advantages and a meta-analysis[J]. Surg Endosc, 2018, 32(11): 4363-4376. DOI: 10.1007/s00464-018-6286-x.
    [12]
    WENG HQ, JIANG JL, SUN HW, et al. Feasibility study of laparoscopic choledocholithotomy for primary suture[J]. Chin J Gen Surg, 2015, 30(10): 819-820. DOI: 10.3760/cma.j.issn.1007-631X.2015.10.022.

    翁汉钦, 蒋基令, 孙宏武, 等. 腹腔镜下胆管测压胆总管一期缝合的可行性研究[J]. 中国普通外科杂志, 2015, 30(10): 819-820. DOI: 10.3760/cma.j.issn.1007-631X.2015.10.022.
    [13]
    LEONG HY, CHANG YK, OOI CW, et al. Liquid biphasic electric partitioning system as a novel integration process for betacyanins extraction from red-purple pitaya and antioxidant properties assessment[J]. Front Chem, 2019, 7: 201. DOI: 10.3389/fchem.2019.00201.
    [14]
    COHEN J, PLESKOW D. The long road to stone management in the bile duct - what else to wish?[J]. Endoscopy, 2019, 51(10): 907-908. DOI: 10.1055/a-0982-3278.
    [15]
    WEN ZQ, SONG Y, ZHANG YM, et al. Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra-and extrahepatic bile duct stones[J]. J Clin Hepatol, 2016, 32(6): 1145-1148. DOI: 10.3969/j.issn.1001-5256.2016.06.025.

    温治强, 宋越, 张耀明, 等. 腹腔镜联合胆道镜、十二指肠镜治疗胆囊结石合并肝内外胆管结石的效果观察[J]. 临床肝胆病杂志, 2016, 32(6): 1145-1148. DOI: 10.3969/j.issn.1001-5256.2016.06.025.
    [16]
    WANG J, CHEN W. Treatment strategies of complicated extrahepatic bileduct stones[J]. Chin J Dig Surg, 2019, 18(12): 1113-1117. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.005.

    王坚, 陈炜. 复杂肝外胆管结石的治疗策略[J]. 中华消化外科杂志, 2019, 18(12): 1113-1117. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.005.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (778) PDF downloads(44) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return