Objective To summarize the clinical experience on combination of laparoscopy, choledochoscopy, and duodenoscopy in treatment of cholecystolithiasis with small diameter of choledocholith during the same period via multiple approach.
Methods The clinical data of 71 cases of cholecystolithiasis with small diameter(The internal diameter of common bile duct was 4-8 mm)of choledocholith underwent laparoscopic cholecystectomy(LC)plus laparoscopic and endoscopic cholelithotomy plus laparoscopic and endoscopic sphincterotomy(LC+LEC+LEST)from February 2001 to December 2013 in this hospital were analyzed retrospectively. Firstly, the LC and common bile duct exploration was performed, then the ureteral catheter or zebra guide wire was inserted into the common bile duct and duodenum cavity through cystic duct or common bile duct incision. Under the guidance of ureteral catheter or zebra guide wire, the choledochoscope was inserted into the common bile duct and cholelithotomy was performed by stone net or electrohydraulic lithotripsy. Then, the duodenoscope was inserted into the papillary of duodenum, the papillary of duodenum was cut by the pin-headlike electro-knife along the ureteric catheter or zebra guide wire, choledocholith was removed with the reticulation of choledochoscopy and duodenoscopy.
Results LC+LEC+LEST was successfully performed on 71 cases of cholecystolithiasis with small diameter of choledocholith. The placement of a catheter via cystic incision was in 59 cases, via common bile duct incision was in 22 cases. The common bile duct stones of 64 patients were completely removed under the choledochoscope, of 12 patients were completely removed under the combination of choledochoscope and duodenoscope. No case was converted to laparotomy. The bile leakage occurred in 5 cases and cured by patent drainage. The slight pancreatitis occurred in one case after operation. There was no patient with residual stones, perforations of intestine and bile duct, hemorrhoea, severe pancreatitis, or death.
Conclusion If patients are indicated, LC+LEC+LEST is safe and effective to remove the cholecystolithiasis with small diameter of choledocholith.
Citation：
CHENAn-ping, HUTing, LIHua-lin, WANGJia-mu, SUOYun-sheng, LIUAn, YIBin, ZHANGSheng-long. Combination of Laparoscopy, Choledochoscopy, and Duodenoscopy in Treatment of Cholecystolithiasis with Small Diameter of Choledocholith(Report of 71 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 946-950. doi: 10.7507/1007-9424.20140227
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis[J]. Langenbecks Arch Surg, 2011, 396(1): 53-62.
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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.
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Ahmed I, Pradhan C, Beckingham IJ, et al. Is a T-tube necessary after common bile duct exploration?[J]. World J Surg, 2008, 32(7): 1485-1488.
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陈安平, 徐俊波, 索运生, 等.腹腔镜术中联合十二指肠镜治疗细径胆总管结石121例报告[J/CD].中华普外科手术学杂志:电子版, 2009, 3(4): 29-31.
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Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones[J]. Surg Endosc, 2011, 25(4): 1230-1237.
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| 11. |
李波, 陈安平, 索运生, 等.腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例[J/CD].中华腔镜外科杂志:电子版, 2011, 3(1): 36-40.
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| 12. |
王佳牧, 陈安平, 山长星, 等.腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告[J].外科研究与新技术, 2013, 2(3): 170-172.
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- 1. 吴孟超, 吴在德.黄家驷外科学[M].北京:人民卫生出版社, 2008: 1797.
- 2. 郭鑫, 陈安平, 李波, 等.腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石[J/CD].中华普外科手术学杂志:电子版, 2012, 6(1): 70-75.
- 3. Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy[J]. Surg Endosc, 2007, 21(12): 2317-2321.
- 4. 李波, 陈安平, 索运生, 等.腹腔镜胆总管探查即时缝合术983例报告[J/CD].中华腔镜外科杂志:电子版, 2010, 3(5): 411-415.
- 5. Leida Z, Ping B, Shuguang W, et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy[J]. Surg Endosc, 2008, 22(7): 1595-1600.
- 6. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis[J]. Langenbecks Arch Surg, 2011, 396(1): 53-62.
- 7. 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.
- 8. Ahmed I, Pradhan C, Beckingham IJ, et al. Is a T-tube necessary after common bile duct exploration?[J]. World J Surg, 2008, 32(7): 1485-1488.
- 9. 陈安平, 徐俊波, 索运生, 等.腹腔镜术中联合十二指肠镜治疗细径胆总管结石121例报告[J/CD].中华普外科手术学杂志:电子版, 2009, 3(4): 29-31.
- 10. Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones[J]. Surg Endosc, 2011, 25(4): 1230-1237.
- 11. 李波, 陈安平, 索运生, 等.腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例[J/CD].中华腔镜外科杂志:电子版, 2011, 3(1): 36-40.
- 12. 王佳牧, 陈安平, 山长星, 等.腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告[J].外科研究与新技术, 2013, 2(3): 170-172.
