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.
ObjectiveTo evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. MethodsClinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complications between the 2 groups were compared. ResultsCompared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients(P < 0.05), there were no significant difference in operative time and bleeding during operation of 2 groups(P > 0.05), The incidence of postoperative complications in the observation group was significantly lower than the control group(P < 0.05). In 122 patients, 105 cases were followed-up(86.1%), the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. ConclusionsBile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct incision and T tubedrainage.