Clinical Comparative Analysis of LC＋LCBDE and ERCP/EST＋LC for Cholecystolithiasis with Choledocholithiasis Patients with Obstructive Jaundice_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YOU Zhen ,  YE Hui , XIONG Xianze , CHEN Liping , LI Ning , JIA Qianbin

Department of Bile Duct Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

YE Hui, Email: yehui86@hotmail.com

Keywords：

Cholecystolithiasis; Choledocholithiasis; Laparoscopic common bile duct exploration; Endoscopic retrograde cholangiopancreatography; Obstructive jaundice

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopic
common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-
rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice.
Methods 　The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January
2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）.
Results 　①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-
operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-
tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/
EST＋LC group （P＜0.05）.
Conclusions 　Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies for
cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-
ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.

Citation： YOU Zhen,YE Hui,XIONG Xianze,CHEN Liping,LI Ning,JIA Qianbin. Clinical Comparative Analysis of LC＋LCBDE and ERCP/EST＋LC for Cholecystolithiasis with Choledocholithiasis Patients with Obstructive Jaundice. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1268-1271. doi: Copy

1.	邹声泉. 胆道病学[M]. 北京：人民卫生出版社， 2010：355.
2.	Memon MA， Hassaballa H， Memon MI. Laparoscopic common bile duct exploration：the past， the present， and the future[J]. Am J Surg， 2000， 179(4)：309-315.
3.	Shuchleib S， Chousleb A， Mondragon A， et al. Laparoscopic common bile duct exploration[J]. World J Surg， 1999， 23(7)：698-702.
4.	彭颖，王立新. 胆囊结石合并胆总管结石微创治疗方法比较[J]. 中国微创外科杂志， 2007， 7(2)：115-117.
5.	刘万涛，吴振华，李常恩，等. 两种不同微创术式治疗胆囊结石合并胆总管结石效果比较的系统评价[J]. 中国循证医学杂志， 2011， 11(11)：1313-1320.
6.	van der Gaag NA， Kloek JJ， de Castro SM， et al. Preoperative biliary drainage in patients with obstructive jaundice：history and current status[J]. J Gastrointest Surg， 2009， 13(4)：814-820.
7.	Neoptolemos JP， Shaw DE， Carr-Locke DL. A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment[J]. Ann Surg， 1989， 209(2)：157-161.
8.	Wright BE， Freeman ML， Cumming JK， et al. Current management of common bile duct stones：is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?[J]. Surgery， 2002， 132(4)：729-737.
9.	蔡杰，邬善敏，李蔚，等. LC＋LCBDE与EST＋LC治疗继发性胆总管结石疗效的Meta分析[J]. 武汉大学学报：医学版， 2013， 34(1)：90-94.
10.	Morino M， Baracchi F， Miglietta C， et al. Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones[J]. Ann Surg， 2006， 244(6)：889-896.
11.	Andriulli A， Loperfido S， Napolitano G， et al. Incidence rates of post-ERCP complications：a systematic survey of prospective studies[J]. Am J Gastroenterol， 2007， 102(8)：1781-1788.
12.	Wang P， Li ZS， Liu F， et al. Risk factors for ERCP-related complications：a prospective multicenter study[J]. Am J Gastroenterol， 2009， 104(1)：31-40.
13.	Masci E， Toti G， Mariani A， et al. Complications of diagnostic and therapeutic ERCP：a prospective multicenter study[J]. Am J Gastroenterol， 2001， 96(2)：417-423.
14.	Lau JY， Leow CK， Fung TM， et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients[J]. Gastroenterology， 2006， 130(1)：96-103.
15.	Nathanson LK， O’Rourke NA， Martin IJ， et al. Postoperative ERCP versus laparoscopic choledochotomy for clearance of sele-cted bile duct calculi：a randomized trial[J]. Ann Surg， 2005， 242(2)：188-192.
16.	Bergman JJ， van Berkel AM， Groen AK， et al. Biliary manometry， bacterial characteristics， bile composition， and histologic changes fifteen to seventeen years after endoscopic sphincterotomy[J]. Gastrointest Endosc， 1997， 45(5)：400-405.
17.	Yamakawa T， Sakai S， Mu ZB， et al. Laparoscopic management of common bile duct stones[J]. J Hepatobiliary Pancreat Surg， 2000， 7(1)：9-14.
18.	Tranter SE， Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct[J]. Br J Surg， 2002， 89(12)：1495-1504.
19.	Lu J， Cheng Y， Xiong XZ， et al. Two-stage vs single-stage mana-gement for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol， 2012， 18(24)：3156-3166.
20.	Urbach D， Khajanchee Y， Jobe B， et al. Cost-effective management of common bile duct stones：a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP)， intraoperative cholangiography， and laparoscopic bile duct exploration[J]. Surg Endosc， 2001， 15(1)：4-13.
21.	Griniatsos J， Karvounis E， Arbuckle J， et al. Cost-effective met-hod for laparoscopic choledochotomy[J]. ANZ J Surg， 2005， 75(1-2)：35-38.
22.	Poulose BK， Speroff T， Holzman MD. Optimizing choledocholithiasis management：a cost-effectiveness analysis[J]. Arch Surg， 2007， 142(1)：43-49.
23.	Cuschieri A， Lezoche E， Morino M， et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi[J]. Surg Endosc， 1999， 13(10)：952-957.
24.	Rogers SJ， Cello JP， Horn JK， et al. Prospective randomized trial of LC＋LCBDE vs ERCP/S＋LC for common bile duct stone disease[J]. Arch Surg， 2010， 145(1)：28-33.
25.	Noble H， Whitley E， Norton S， et al. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration[J]. Surg Endosc， 2011， 25(1)：130-139.

1. 邹声泉. 胆道病学[M]. 北京：人民卫生出版社， 2010：355.
2. Memon MA， Hassaballa H， Memon MI. Laparoscopic common bile duct exploration：the past， the present， and the future[J]. Am J Surg， 2000， 179(4)：309-315.
3. Shuchleib S， Chousleb A， Mondragon A， et al. Laparoscopic common bile duct exploration[J]. World J Surg， 1999， 23(7)：698-702.
4. 彭颖，王立新. 胆囊结石合并胆总管结石微创治疗方法比较[J]. 中国微创外科杂志， 2007， 7(2)：115-117.
5. 刘万涛，吴振华，李常恩，等. 两种不同微创术式治疗胆囊结石合并胆总管结石效果比较的系统评价[J]. 中国循证医学杂志， 2011， 11(11)：1313-1320.
6. van der Gaag NA， Kloek JJ， de Castro SM， et al. Preoperative biliary drainage in patients with obstructive jaundice：history and current status[J]. J Gastrointest Surg， 2009， 13(4)：814-820.
7. Neoptolemos JP， Shaw DE， Carr-Locke DL. A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment[J]. Ann Surg， 1989， 209(2)：157-161.
8. Wright BE， Freeman ML， Cumming JK， et al. Current management of common bile duct stones：is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?[J]. Surgery， 2002， 132(4)：729-737.
9. 蔡杰，邬善敏，李蔚，等. LC＋LCBDE与EST＋LC治疗继发性胆总管结石疗效的Meta分析[J]. 武汉大学学报：医学版， 2013， 34(1)：90-94.
10. Morino M， Baracchi F， Miglietta C， et al. Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones[J]. Ann Surg， 2006， 244(6)：889-896.
11. Andriulli A， Loperfido S， Napolitano G， et al. Incidence rates of post-ERCP complications：a systematic survey of prospective studies[J]. Am J Gastroenterol， 2007， 102(8)：1781-1788.
12. Wang P， Li ZS， Liu F， et al. Risk factors for ERCP-related complications：a prospective multicenter study[J]. Am J Gastroenterol， 2009， 104(1)：31-40.
13. Masci E， Toti G， Mariani A， et al. Complications of diagnostic and therapeutic ERCP：a prospective multicenter study[J]. Am J Gastroenterol， 2001， 96(2)：417-423.
14. Lau JY， Leow CK， Fung TM， et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients[J]. Gastroenterology， 2006， 130(1)：96-103.
15. Nathanson LK， O’Rourke NA， Martin IJ， et al. Postoperative ERCP versus laparoscopic choledochotomy for clearance of sele-cted bile duct calculi：a randomized trial[J]. Ann Surg， 2005， 242(2)：188-192.
16. Bergman JJ， van Berkel AM， Groen AK， et al. Biliary manometry， bacterial characteristics， bile composition， and histologic changes fifteen to seventeen years after endoscopic sphincterotomy[J]. Gastrointest Endosc， 1997， 45(5)：400-405.
17. Yamakawa T， Sakai S， Mu ZB， et al. Laparoscopic management of common bile duct stones[J]. J Hepatobiliary Pancreat Surg， 2000， 7(1)：9-14.
18. Tranter SE， Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct[J]. Br J Surg， 2002， 89(12)：1495-1504.
19. Lu J， Cheng Y， Xiong XZ， et al. Two-stage vs single-stage mana-gement for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol， 2012， 18(24)：3156-3166.
20. Urbach D， Khajanchee Y， Jobe B， et al. Cost-effective management of common bile duct stones：a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP)， intraoperative cholangiography， and laparoscopic bile duct exploration[J]. Surg Endosc， 2001， 15(1)：4-13.
21. Griniatsos J， Karvounis E， Arbuckle J， et al. Cost-effective met-hod for laparoscopic choledochotomy[J]. ANZ J Surg， 2005， 75(1-2)：35-38.
22. Poulose BK， Speroff T， Holzman MD. Optimizing choledocholithiasis management：a cost-effectiveness analysis[J]. Arch Surg， 2007， 142(1)：43-49.
23. Cuschieri A， Lezoche E， Morino M， et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi[J]. Surg Endosc， 1999， 13(10)：952-957.
24. Rogers SJ， Cello JP， Horn JK， et al. Prospective randomized trial of LC＋LCBDE vs ERCP/S＋LC for common bile duct stone disease[J]. Arch Surg， 2010， 145(1)：28-33.
25. Noble H， Whitley E， Norton S， et al. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration[J]. Surg Endosc， 2011， 25(1)：130-139.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Comparative Analysis of LC＋LCBDE and ERCP/EST＋LC for Cholecystolithiasis with Choledocholithiasis Patients with Obstructive Jaundice

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