目的 探讨输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石的方法及疗效。方法 传统方法取石失败病例改用输尿管镜置入胆总管直视见到胆总管下段嵌顿性结石，气压弹道碎石，盐水冲洗出或钳夹出结石，并探查下段是否通畅。结果 清除结石时间5~10 min，成功率100%（19/19），术后2~4周拔T管，无切口感染、无胆道感染、无残留结石。结论 输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石，高效、安全，值得临床推广应用。
Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
Objective To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.
目的探讨腹腔镜联合胆道镜治疗胆囊及胆总管结石的临床疗效。 方法回顾性分析2010年1月至2013年1月期间收治于笔者所在科室的96例胆囊及胆总管结石患者的临床资料，根据手术方式分为开腹组、腹腔镜联合胆道镜＋T管引流术组和腹腔镜联合胆道镜＋放置鼻胆管一期缝合组3组。对3组患者的手术时间、术中出血量、肛门排气时间、住院时间、残石率、复发率、并发症发生率、手术有效率及术后淀粉酶和肝功能指标水平进行对比分析。 结果微创手术组与开腹组比较，患者的出血量、肛门排气时间、住院时间、残石率、复发率及并发症发生率均减少、缩短或降低，同时手术的有效率提高（P＜0.05）；腹腔镜联合胆道镜＋放置鼻胆管一期缝合组术后淀粉酶和肝功能指标的水平较其他2组明显降低（P＜0.05）。 结论微创手术创伤小，残石率及复发率低，并发症少，患者术后恢复快，是一种安全有效的治疗方式，值得临床推广应用。
ObjectiveTo summarize experience of laparoscopy combined with choledochoscopy common bile duct exploration for patients with schistosomiasis liver cirrhosis with common bile duct stones. MethodThe clinical data of 45 patients with schistosomiasis liver cirrhosis combined with common bile duct stones (liver function Child-Pugh grade A and B) admitted in this hospital from September 2012 to September 2015 were analyzed retrospectively. ResultsTwenty cases were successfully treated by laparoscopy combined with choledochoscopy (laparoscope group), 25 cases were treated by conventional open common bile duct exploration (laparotomy group). Two cases were converted to laparotomy due to bleeding during laparoscopic operation. The mean operation time, intraoperative bleeding, postopera-tive hospitalization time, and postoperative total complications rate had no significant differences between these two groups (P>0.05). There were 2 cases of pulmonary infection and 1 case of incision infection in the laparoscope group, and 1 case of grade A bile leakage and 1 case of pulmonary infection in the laparotomy group, there was no common bile duct stone residual in these two groups. ConclusionAlthough laparoscopic surgery is more difficult for schistosomiasis liver cirrhosis combined with common bile duct stones patients, it is safe and feasible. Appropriate perioperative management and precise laparoscopic and choledochoscopic operation are key to success of operation.
ObjectiveTo explore the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and LC combined with laparoscopiccommom bile duct exploration and primary sture (LBDEPS) in the treatment of cholecystolithiasis complicated with choledocholithiasis in the elderly (age more than 75 years old).MethodsThe elderly patients with cholecystolithiasis complicated with choledocholithiasis in the Tianyou Hospital Affiliated to Wuhan University of Science and Technology from March 1, 2018 to June 30, 2019 were retrospectively collected, then were designed into an ERCP combined with LC therapy group (ERCP+LC group) and a LC combined with LBDEPS therapy group (LC+LBDEPS group) according to the therapy methods. The operative indexes (total operation time, general anesthesia time, intraoperative bleeding volume, LC conversion to laparotomy) and postoperative indexes (conversion to ICU, use time of ventilator in the ICU, drainage tube indwelling time, ventilation time, time of getting out of bed, postoperative hospitalization time, total hospitalization time, total hospitalization costs, stone clearance rate, and complications) were compared between the two groups.ResultsIn this study, 67 patients were collected, including 35 patients in the ERCP+LC group and 32 patients in the LC+LBDEPS group. There were no significant differences between the two groups in the terms of baseline data, such as the patients’ gender, age, preoperative symptoms, preoperative complications, number of choledocholithiasis, maximum diameter of choledocholithiasis, and diameter of common bile duct, etc. (P>0.05). Compared with the LC+LBDEPS group, the ERCP+LC group had more advantages in the terms of the total operation time, general anesthesia time, intraoperative bleeding, rate of LC conversion to laparotomy, time of ventilator use in the ICU, postoperative ventilation time, postoperative time of getting out of bed, and drainage tube indwelling time (P<0.05). The others indexes had no significant differences between the two groups (P>0.05).ConclusionsAccording to the results of this study, therapeutic efficacy of ERCP+LC and LC+LBDEPS in treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis have no significant differences, but ERCP+LC therapy has more advantages than LC+LBDEPS in total operation time, general anesthesia time, intraoperative bleeding, LC conversion to laparotomy, postoperative recovery and so on, and appropriate operation mode might be selected according to specific situation of patients and local medical conditions.
【摘要】目的 探讨十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石的治疗效果。 方法 采用十二指肠镜取出胆总管结石后，再用腹腔镜切除胆囊治疗胆囊结石合并胆总管结石病例的方法。 结果 51例患者的治疗均获得成功。 结论 胆囊结石合并胆总管结石的病例，通过十二指肠镜取出胆总管结石后，再行腹腔镜胆囊切除术，可避免开腹或腹腔镜胆总管探查等操作较复杂、创伤较大的手术方式。
ObjectiveTo explore how to select the suitable indications of ERCP for clinical diagnosis and treatment. MethodsThe data of patients treated by ERCP between January 2005 and December 2009 in our hospital were analyzed retrospectively. ResultsTotal 221 patients received ERCP, among whom 99 (45%) cases of common bile duct stones, 44 (20%) cases of malignant tumor, 9 (4%) cases of papilla narrow, 45 (20%) cases were negative, and 24 (11%) cases were failed. It had the trend that the number of the patients received ERCP reduced year by year. The postoperative complication rate was 11% (25 cases), including 15 cases of postoperative pancreatitis, 3 cases of bleeding, 5 cases of biliary duct infection, and 2 cases of basket stranded. ConclusionIn the modern medical condition, with the advancement of image and laparoscopy technology, we should select the diagnosis and treatment methods with the principles of no damage or less damage for patients, without unlimitedly broadening the clinical indications of ERCP.