Objective To investigate the method of the treatment on cholecystolithiasis combined with calculus of common bile duct (CBD) by laparoscopy with combination of choledochoscope and duodenoscope and its significances. Methods Forty-two patients with cholecystolithiasis combined with calculus of CBD were treated by laparoscopy with combination of choledochoscope and duodenoscope from Jan. 2007 to Dec. 2008 in this hospital. Under general anesthesia, laparoscopic cholecystectomy was performed first, then the anterior wall of CBD was opened, calculus of CBD was treated by choledochoscope and duodenoscope intraoperatively. Then primary suture of the CBD was performed under laparoscope and nasobiliary drainage duct was placed. Results One case was converted to laparotomy, 41 cases succeeded and left hospital after being taken off the nasobiliary drainage duct in 5-7 d. No case died, no bile leakage, no bleeding or perforation of upper digestive tract, and no acute pancreatitis happened after operation. Conclusion Laparoscopy with combination of choledochoscope and duodenoscope treating cholecystolithiasis combined with calculus of CBD is a safe, effective and quickly recovering method with less sufferings and trauma.
ObjectiveTo 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. MethodsThe 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. ResultsLC+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. ConclusionIf patients are indicated, LC+LEC+LEST is safe and effective to remove the cholecystolithiasis with small diameter of choledocholith.