Comparison of Clinical Effectiveness on Two Kinds of Minimally Invasive Treatment for Cholecystolithiasis with Choledocholithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Sheng ¹ , ZHENG Jianghua ¹ , OU Yingliang ¹ , CHEN Wei ¹ , JIANG Yin ² , JIAN Zhixiang ¹ , WANG Weidong. ¹

1. The First Department of General Surgery， Guangdong Academy of Medical Sciences and Guangdong Provincial People’s Hospital， Guangzhou 510080， Guangdong Province， China;;
2. LI Hui-li Hospital， Medical Center of Ningbo， Ningbo 315000， Zhejiang Province， China;

Corresponding author：

Keywords：

Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Endoscopic retrograde cholangiopancreatography/endoscopic sphincterectomy; Cholecystolithiasis with choledocholithiasis

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Objective 　To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincterectomy with LC（ERCP/EST＋LC） in treatment for cholecystolithiasis with choledocholithiasis.
Methods 　From January 2008 to July 2011， 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC＋LCBDE（85 cases， LC＋LCBDE group） or ERCP/EST＋LC（42 cases， ERCP/EST＋LC group） were collected retrospectively. The clearance rate of calculus， hospital stay， hospitalization expenses， and the rate of postoperative complications were compared between two groups.
Results 　Eighty-five patients were performed successfully in the LC＋LCBDE group， out of which 54 patients had primary closure of common bile duct （LC＋LCBDE primary closure group）， whereas in 28 patients common bile ducts were closed over T tube （LC＋LCBDE＋T tube group）. Forty-two patients were performed successfully in the ERCP/EST＋LC group. There were no differences in the clearance rate of calculus〔100%（82/82） versus 97.37%（37/38）， P=0.317〕 and postoperative complications rate 〔（4.71% （4/85） versus 4.76%（2/42）， P=1.000〕 between the LC＋LCBDE group and ERCP/EST＋LC group. The median （quartile） hospital stay in the LC＋LCBDE group was shorter than that in the ERCP/EST＋LC group 〔12 （6） d versus 17（9） d， P＜0.001〕. In the LC＋LCBDE primary closure group， both median （quartile）?hospital stay and median（quartile） hospitalization expenses were less than those of ERCP/EST＋LC〔hospital stay：11（5） d versus 17（9） d， P＜0.001；hospitalization expenses：27 054（8 452） yuan versus 31 595（11 743） yuan， P=0.005〕 .
Conclusions 　In the management of patients suffered from cholecystolithiasis with choledocholithiasis， both LC＋LCBDE and ERCP/EST＋LC are safe and effective. LC＋LCBDE， especially primary closure after LCBDE， is associated with significantly less costs as compared with ERCP/EST＋LC. Moreover， patients can be cured by LC＋LCBDE through one-stage treatment with the protection of the papilla function and no limits to the amount or size of the choledocholithiasis. The LC＋LCBDE is a preferable choice for the appropriate cases of cholecystolithiasis with choledocholithiasis.

Citation： CHEN Sheng,ZHENG Jianghua,OU Yingliang,CHEN Wei,JIANG Yin,JIAN Zhixiang,WANG Weidong.. Comparison of Clinical Effectiveness on Two Kinds of Minimally Invasive Treatment for Cholecystolithiasis with Choledocholithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(11): 1213-1217. doi: Copy

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5.	Sgourakis G， Lanitis S， Karaliotas C， et al. Laparoscopic versus endoscopic primary management of choledocholithiasis ：A retrospective case-control study[J]. Chirurg， 2012 Apr 4. [Epub ahead of print].
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9.	Rogers SJ， Cello JP， Horn JK， et al. Prospective randomized trialof LC＋LCBDE vs ERCP/S＋LC for common bile duct stone disease[J]. Arch Surg， 2010， 145(1)：28-33.
10.	Topal B， Vromman K， Aerts R， et al. Hospital cost categories of one-stage versus two-stage management of common bile duct stones[J]. Surg Endosc， 2010， 24(2)：413-416.
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12.	王广义，王英超，吕国悦. 胆囊结石合并胆总管结石的现代外科治疗模式[J]. 世界华人消化杂志， 2009， 17(35)：3579-3582.
13.	张成，安东均，马富平，等. 十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石[J]. 中国微创外科杂志， 2008， 83(2)：151-152.
14.	陈平，别平，王曙光，等. 腹腔镜胆道探查取石胆囊切除术与ERCP加腹腔镜胆囊切除术的疗效比较[J]. 第三军医大学学报， 2003， 25(13)：1188-1190.
15.	刘岳松，李明宏，王建华. 腹腔镜及内镜治疗胆总管结石(附41例报道)[J]. 中国普外基础与临床杂志， 2011， 18(4)：430-431.
16.	张瑞，徐钧，侯波. 两种微创术式治疗胆囊结石合并胆总管结石的临床比较[J]. 山西医科大学学报， 2010， 41(11)：989-991.
17.	马振，宿华威. 微创时代胆囊结石合并胆总管结石的外科治疗[J]. 中国误诊学杂志， 2011， 11(36)：8838-8840.
18.	李红阳，刘长安. 肝外胆管结石微创治疗进展[J] . 广东医学， 2011， 32(15)：2071-2073.
19.	Samardzic J， Latic F， Kraljik D， et al. Treatment of common bile duct stones-is the role of ERCP changed in era of minimally invasive surgery?[J]. Med Arh， 2010， 64(3)：187-188.
20.	徐小东，吕西，李徐生，等. 胆总管结石的微创治疗[J]. 中国微创外科杂志， 2010， 10(6)：533-534.
21.	Sgouros SN， Pereira SP. Systematic review：sphincter of Oddi dysfunction-non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy[J]. Aliment Pharmacol Ther， 2006， 24(2)：237-246.
22.	张日新，郑直，何涛，等. 腹腔镜胆总管探查取石术后胆管一期缝合与T管引流比较的系统评价[J]. 中国循证医学杂志， 2011， 11(10)：1161-1165.
23.	刘晖，亚力坤，斯坎德尔，等. 胆总管切开取石一期缝合与“T”管引流的对比研究[J]. 肝胆外科杂志， 2011， 19(4)：290-292.
24.	杜嘉林，区应亮，王卫东. 腹腔镜胆总管探查术67例临床分析[J]. 中华消化内镜杂志， 2001， 18(2)：108-109.
25.	邹浩，朱红，张小文，等. 胆囊结石合并胆总管结石微创治疗方式的选择[J]. 广东医学， 2011， 32(10)：1319-1321.
26.	Savita KS， Bhartia VK. Laparoscopic CBD exploration[J].Indian J Surg， 2010， 72(5)：395-399.

1. Gurusamy KS， Samraj K. Primary closure versus T-tube drainage after open common bile duct exploration[J]. Cochrane Database Syst Rev， 2007， (1)：CD005640.
2. 陶涛，石刚，彭祥玉，等. 腹腔镜和胆道镜联合治疗胆总管结石(附523例报道)[J]. 中国普外基础与临床杂志， 2009， 16(8)：649-653.
3. 于澜，张抒，黄德全，等. 腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并胆总管结石[J]. 中国普外基础与临床杂志， 2010， 17(4)：323-325.
4. 戈佳云，魏东，王琳，等. 联合微创治疗胆囊合并胆总管结石82例临床分析[J]. 昆明医学院学报， 2009， 30(10)：112-115.
5. Sgourakis G， Lanitis S， Karaliotas C， et al. Laparoscopic versus endoscopic primary management of choledocholithiasis ：A retrospective case-control study[J]. Chirurg， 2012 Apr 4. [Epub ahead of print].
6. Kroh M， Chand B. Choledocholithiasis， endoscopic retrograde cholangiopancreatography， and laparoscopic common bile duct exploration[J]. Surg Clin North Am， 2008， 88(5)：1019-1031.
7. Lu J， Cheng Y， Xiong XZ， et al. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol， 2012， 18(24)：3156-3166.
8. Li M， Tang C， Lai E. Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era：A systematic review[J]. Asian J Endosc Surg， 2011， 4(2)：53-58.
9. Rogers SJ， Cello JP， Horn JK， et al. Prospective randomized trialof LC＋LCBDE vs ERCP/S＋LC for common bile duct stone disease[J]. Arch Surg， 2010， 145(1)：28-33.
10. Topal B， Vromman K， Aerts R， et al. Hospital cost categories of one-stage versus two-stage management of common bile duct stones[J]. Surg Endosc， 2010， 24(2)：413-416.
11. Bansal VK， Misra MC， Garg P， et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones[J]. Surg Endosc， 2010， 24(8)：1986-1989.
12. 王广义，王英超，吕国悦. 胆囊结石合并胆总管结石的现代外科治疗模式[J]. 世界华人消化杂志， 2009， 17(35)：3579-3582.
13. 张成，安东均，马富平，等. 十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石[J]. 中国微创外科杂志， 2008， 83(2)：151-152.
14. 陈平，别平，王曙光，等. 腹腔镜胆道探查取石胆囊切除术与ERCP加腹腔镜胆囊切除术的疗效比较[J]. 第三军医大学学报， 2003， 25(13)：1188-1190.
15. 刘岳松，李明宏，王建华. 腹腔镜及内镜治疗胆总管结石(附41例报道)[J]. 中国普外基础与临床杂志， 2011， 18(4)：430-431.
16. 张瑞，徐钧，侯波. 两种微创术式治疗胆囊结石合并胆总管结石的临床比较[J]. 山西医科大学学报， 2010， 41(11)：989-991.
17. 马振，宿华威. 微创时代胆囊结石合并胆总管结石的外科治疗[J]. 中国误诊学杂志， 2011， 11(36)：8838-8840.
18. 李红阳，刘长安. 肝外胆管结石微创治疗进展[J] . 广东医学， 2011， 32(15)：2071-2073.
19. Samardzic J， Latic F， Kraljik D， et al. Treatment of common bile duct stones-is the role of ERCP changed in era of minimally invasive surgery?[J]. Med Arh， 2010， 64(3)：187-188.
20. 徐小东，吕西，李徐生，等. 胆总管结石的微创治疗[J]. 中国微创外科杂志， 2010， 10(6)：533-534.
21. Sgouros SN， Pereira SP. Systematic review：sphincter of Oddi dysfunction-non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy[J]. Aliment Pharmacol Ther， 2006， 24(2)：237-246.
22. 张日新，郑直，何涛，等. 腹腔镜胆总管探查取石术后胆管一期缝合与T管引流比较的系统评价[J]. 中国循证医学杂志， 2011， 11(10)：1161-1165.
23. 刘晖，亚力坤，斯坎德尔，等. 胆总管切开取石一期缝合与“T”管引流的对比研究[J]. 肝胆外科杂志， 2011， 19(4)：290-292.
24. 杜嘉林，区应亮，王卫东. 腹腔镜胆总管探查术67例临床分析[J]. 中华消化内镜杂志， 2001， 18(2)：108-109.
25. 邹浩，朱红，张小文，等. 胆囊结石合并胆总管结石微创治疗方式的选择[J]. 广东医学， 2011， 32(10)：1319-1321.
26. Savita KS， Bhartia VK. Laparoscopic CBD exploration[J].Indian J Surg， 2010， 72(5)：395-399.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Clinical Effectiveness on Two Kinds of Minimally Invasive Treatment for Cholecystolithiasis with Choledocholithiasis

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