Comparison of the efficacy of LC+LCBDE one-stage surgical procedure and ERCP+LC two-stage surgical procedure in the treatment of small diameter choledocholithiasis combined with gallbladder stones
Cai Xuejun, Li Yongyuan, Shen Jianwei, Zhang Liming, Shao Zhijiang
Department of Hepatobiliary Surgery, Tianjin No. 5 Central Hospital (Peking University Binhai Hospital), Tianjin 300450, China
Abstract：Objective This study aimed to investigate the surgical protocol of combined laparoscopic and cholangioscopic double-scope one-stage procedure of small diameter choledocholithiasis combined with gallbladder stones and the classical duodenoscopic and laparoscopic two-stage procedure and to compare the clinical efficacy of the two different surgical treatments. Methods A retrospective analysis was conducted on 121 patients (80 males and 41 females; 18-84 years old) with small diameter common bile duct (diameter ≤0.8 cm) stones combined with gallbladder stones who were admitted to Tianjin No. 5 Central Hospital from April 2016 to August 2020. The patients were divided into two groups according to the different treatment methods. The first group (59 patients) was treated with the combined method of duodenoscopic extraction of common bile duct stones and laparoscopic cholecystectomy (i.e., ERCP+LC), whereas the second group (62 patients) was treated with laparoscopic cholecystectomy + intraoperative choledochoscopy via cystic duct route lithotripsy (i.e., LC+LCBDE). The length of hospital stay, liver function indexes, and complications were compared between the two groups. Results No statistically significant differences were found in the gender composition ratio, age, and the diameter of the common bile duct and the number of stones between the two groups (all P values > 0.05). The mean length of stay in the LC+LCBDE group ([9.32 ± 5.20] days) was lower than that in the ERCP+LC group ([13.35 ± 8.67] days), and the difference was statistically significant (t=3.12,P = 0.002). The ALT ([36.5±15.2] U/L) at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group ([73.1±53.7] U/L), and the AST ([36.3±11.2] U/L) at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group ([55.5±40.3] U/L); the difference was statistically significant (t=5.16, t=3.61, all P values <0.001). No significant difference was found between the TBIL and DBIL (t=0.85, t=1.29, all P values >0.05) of the two groups at 1 day before discharge. Two patients (3.3%) in the ERCP+LC group had elevated amylase levels and one patient (1.6%) in the LC+LCBDE group had biliary leakage after operation. No statistically significant difference was found in the occurrence of complications between the two groups (χ2=0.63, P=0.529). Conclusion Compared with the ERCP+LC treatment, the LC+LCBDE treatment for small diameter common bile duct stones has advantages of shorter hospital stay and faster recovery of liver function. The LC+LCBDE treatment avoids the incision of the papillary sphincter. This treatment is safe and effective and has better clinical outcomes. It should be further promoted and applied.
蔡雪军, 李永元, 沈建伟, 张立明, 邵志江. 腹腔镜联合胆道镜一期手术与十二指肠镜联合腹腔镜分期手术治疗细径胆总管结石合并胆囊结石的疗效比较[J]. 中华解剖与临床杂志, 2022, 27(5): 343-348.
Cai Xuejun, Li Yongyuan, Shen Jianwei, Zhang Liming, Shao Zhijiang. Comparison of the efficacy of LC+LCBDE one-stage surgical procedure and ERCP+LC two-stage surgical procedure in the treatment of small diameter choledocholithiasis combined with gallbladder stones. Chinese Journal of Anatomy and Clinics, 2022, 27(5): 343-348.
Taylor AC, Little AF, Hennessy OF, et al.Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree[J]. Gastrointest Endosc, 2002, 55(1):17-22. DOI: 10.1067/mge.2002.120324.
[2]
陈安平,赵聪,陈大夫,等. 腹腔镜胆总管切开取石术治疗细径胆总管结石[J]. 中国实用外科杂志, 2005, 25(11):673-674. DOI:10.3321/j.issn:1005-2208.2005.11.014.Chen AP, Zhao C, Chen DF, et al.Laparoscopic choledocholithotomy for thin choledochus[J]. Chinese Journals of Practical Medicine, 2005, 25(11):37-38. DOI:10.3321/j.issn:1005-2208.2005.11.014.
[3]
程相超,袁启东,赵建红,等. 十二指肠乳头逆向插管治疗胆囊结石伴细径胆总管结石的临床体会[J]. 腹腔镜外科杂志, 2019, 24(6):419-422. DOI:10.13499/j.cnki.fqjwkzz.2019.06.419.Cheng XC, Yuan QD, Zhao JH, et al.Clinical experience of laparoscopic reversed duodenal papillary intubation for the treatment of gallstones with small diameter common bile duct stones[J]. Journal of Laparoscopic Surgery, 2019,24(6):419-422. DOI:10.13499/j.cnki.fqjwkzz.2019.06.419.
[4]
王超, 徐锋, 刘晓琳, 等. 隐匿性胆总管结石诊断与治疗的新进展[J].临床肝胆病杂志, 2017, 33(7):1391-1396. DOI:10.3969/j.issn.1001-5256.2017.07.042.Wang C, Xu F, Liu XL, et al.Latest advances in diagnosis and treatment of occult common bile duct stones[J]. Journal of Clinical Hepatology, 2017, 33(7):1391-1396. DOI:10.3969/j.issn.1001-5256.2017.07.042.
[5]
邓小明,杨星,陈焱,等. 腹腔镜胆囊切除术中隐匿性胆总管结石的微创治疗[J]. 中国微创外科杂志, 2014, 14(9):796-798. DOI:10.3969/j.issn.1009-6604.2014.09.008.Deng XM, Yang X, Chen Y, et al.Minimally invasive therapy for occult choledocholithiasis during laparoscopic cholecystectomy[J]. Chinese Journal of Minimally Invasive Surgery, 2014, 14(9):796-798. DOI:10.3969/j.issn.1009-6604.2014.09.008.
[6]
Sousa M, Pinho R, Proença L, et al.Choledocholithiasis in elderly patients with gallbladder in situ-is ERCP sufficient?[J]. Scand J Gastroenterol, 2018, 53(10-11):1388-1392. DOI: 10.1080/00365521.2018.1524022.
[7]
彭书旺,陈露阳. 腹腔镜下胆道切开取石术和ERCP球囊扩张取石术治疗细径胆管结石的疗效比较[J]. 中国现代手术学杂志, 2019, 23(5):321-325. DOI:10.16260/j.cnki.1009-2188.2019.05.001.Peng SW, Chen LY.Comparison of clinical efficacy between laparoscopic choledocholithotomy and ERCP balloon dilatation in the treatment of fine diameter choledocholithiasis[J]. Chinese Journal of Modern Operative Surgery, 2019, 23(5):321-325. DOI:10.16260/j.cnki.1009-2188.2019.05.001
[8]
石玉琪,许春芳. ERCP联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石术后胆总管结石复发的危险因素分析[J]. 中华消化内镜杂志, 2016, 33(10):689-692. DOI:10.3760/cma.j.issn.1007-5232.2016.10.009.Shi YQ, Xu CF.Risk factors for common bile duct stones recurrence in patients undergoing ERCP and LC[J]. Chin J Dig Endosc, 2016, 33(10):689-692. DOI:10.3760/cma.j.issn.1007-5232.2016.10.009.
[9]
Severino V, Dumonceau JM, Delhaye M, et al. Extracellular vesicles in bile as markers of malignant biliary stenoses[J]. Gastroenterology, 2017, 153(2):495-504.e8. DOI: 10.1053/j.gastro.2017.04.043.
[10]
于凤海,张薇,孙媛媛,等. 治疗性ERCP并发症分析及其防治体会[J]. 中华消化内镜杂志, 2009, 26(5):256-259. DOI:10.3760/cma.j.issn.1007-5232.2009.05.011.Yu FH, Zhang W, Sun YY, et al.Managements and prevention of complications after endoscopic retrograde cholangiopancreatography[J]. Chin J Dig Endosc, 2009, 26(5):256-259. DOI:10.3760/cma.j.issn.1007-5232.2009.05.011.
[11]
管辉球,丁明金,赵国栋. 经胆囊管胆道造影与外引流在腹腔镜胆总管切开一期缝合术中的应用[J]. 中华肝胆外科杂志, 2017, 23(1):24-27. DOI:10.3760/cma.j.issn.1007-8118.2017.01.008.Guan HQ, Ding MJ, Zhao GD.Primary closure after laparoscopic choledochotomy with transcystic cholangiography and biliary drainage[J]. Chin J Hepatobiliary Surg, 2017, 23(1):24-27. DOI:10.3760/cma.j.issn.1007-8118.2017.01.008.
[12]
陈安平,曾乾桃,周华波,等. 腹腔镜胆总管探查一期缝合术的临床疗效(附2429例报告)[J]. 中华消化外科杂志, 2018, 17(3):299-303. DOI:10.3760/cma.j.issn.1673-9752.2018.03.015.Chen AP, Zeng QT, Zhou HB, et al.Clinical efficacy of primary closure in laparoscopic common bile duct exploration (a report of 2 429 cases)[J]. Chin J Dig Surg, 2018, 17(3):299-303. DOI:10.3760/cma.j.issn.1673-9752.2018.03.015.
[13]
张雷达,别平,陈平,等. 腹腔镜胆道探查术后胆管一期缝合与T管引流的疗效比较[J]. 中华外科杂志,2004,42(9):520-523. DOI:10.3760/j:issn:0529-5815.2004.09.003.Zhang LD, Bie P, Chen P, et al.Primary duct closure versus T-tube drainage following laparoscopic choledochotomy[J]. Chin J Surg, 2004, 42(9):520-523. DOI:10.3760/j:issn:0529-5815.2004.09.003.
[14]
吴宝强,胡俊,刘文松,等. 腹腔镜胆囊切除术中右肝动脉重建二例[J]. 中华肝胆外科杂志,2019,25(3):220-221. DOI:10.3760/cma.j.issn.1007-8118.2019.03.014.Wu BQ, Hu J, Liu WS, et al.Right hepatic artery reconstruction in laparoscopic cholecystectomy: report of two cases[J]. Chin J Hepatobiliary Surg, 2019,25(3):220-221. DOI:10.3760/cma.j.issn.1007-8118.2019.03.014.
[15]
梁廷波,白雪莉,陈伟. 腹腔镜胆总管探查术治疗胆总管结石的现状与进展[J]. 中华消化外科杂志,2018,17(1):22-25. DOI:10.3760/cma.j.issn.1673-9752.2018.01.006.Liang TB, Bai XL, Chen W.Current status and progress of laparoscopic common bile duct exploration in the treatment of choledocholithiasis[J]. Chin J Dig Surg, 2018,17(1):22-25. DOI:10.3760/cma.j.issn.1673-9752.2018.01.006.16 ·
2022, Vol. 27 
