Lien Heng-Hui, Huang Chi-Cheng, Huang Ching-Shui, Shi Min-Yen, Chen Der-Fang, Wang Nai-Yuan, Tai Feng-Chuan
Department of General Surgery, Cathay General Hospital, Taipei, Taiwan.
J Laparoendosc Adv Surg Tech A. 2005 Jun;15(3):298-302. doi: 10.1089/lap.2005.15.298.
Although laparoscopic cholecystectomy (LC) has become the gold standard for the management of gallstone disease, the application of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has been slower. The aim of this study is to determine the feasibility and effectiveness of LCBDE. A retrospective cohort study was conducted to compare LCBDE (n = 82) with conventional common bile duct exploration (CCBDE) (n = 75) and endoscopic sphincterotomy (EST) (n = 80) in the management of choledocholithiasis. All our LCBDEs were performed through choledochotomy with T-tube placement. The mean operative time of the LCBDE group (124 +/- 48 minutes) was not significantly longer then the CCBDE group (118 +/- 35 minutes), while the postoperative hospitalization was shorter in both the LCBDE (8 +/- 5 days) and EST (9 +/- 4 days) groups than in the CCBDE (13 +/- 6 days) group. In the LCBDE group, 14 patients (17.1%) required postoperative choledochoscopy to clear residual stones through the T-tube tract. The only mortality occurred in the CCBDE group. The morbidity rate was 3.7% (3/82) in the LCBDE group, including bile leakage in 1 case and bile peritonitis in 2 cases; 6.7% (5/75) in the CCBDE group, including atlectasis in 2 cases, sepsis in 1, and wound infection in 2. There were 2 cases of postoperative pancreatitis (2.5%; 2/80) in the EST group. The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (EST, 1.46 +/- 0.67; LCBDE, 1.23 +/- 0.42; and CCBDE, 1.09 +/- 0.28; P < 0.0001). Our results suggested that EST and LCBDE tended to require more therapeutic sessions then CCBDE, although these sessions were less invasive. The benefits of LCBDE include minimal invasiveness, concurrent treatment of gallbladder stone and CBD stones in a single session, and a shorter postoperative hospital stay. However a longer learning curve is needed. Selection of the most suitable therapeutic option for individual patients by an experienced surgeon gives the most benefits to patients.
尽管腹腔镜胆囊切除术（LC）已成为胆结石疾病治疗的金标准，但腹腔镜胆总管探查术（LCBDE）在胆总管结石治疗中的应用发展较为缓慢。本研究的目的是确定LCBDE的可行性和有效性。我们进行了一项回顾性队列研究，比较了LCBDE（n = 82）、传统胆总管探查术（CCBDE，n = 75）和内镜括约肌切开术（EST，n = 80）在胆总管结石治疗中的效果。所有LCBDE手术均通过胆总管切开并放置T管进行。LCBDE组的平均手术时间（124±48分钟）并不显著长于CCBDE组（118±35分钟），而LCBDE组（8±5天）和EST组（9±4天）的术后住院时间均短于CCBDE组（13±6天）。在LCBDE组中，14例患者（17.1%）术后需要通过T管窦道进行胆道镜检查以清除残留结石。唯一的死亡病例发生在CCBDE组。LCBDE组的发病率为3.7%（3/82），包括1例胆漏和2例胆汁性腹膜炎；CCBDE组为6.7%（5/75），包括2例肺不张、1例脓毒症和2例伤口感染。EST组有2例术后胰腺炎（2.5%；2/80）。每组完全清除胆总管结石所需的平均治疗次数差异具有统计学意义（EST，1.46±0.67；LCBDE，1.23±0.42；CCBDE，1.09±0.28；P < 0.0001）。我们的结果表明，尽管EST和LCBDE的侵入性较小，但与CCBDE相比，它们往往需要更多的治疗次数。LCBDE的优点包括微创性、可在一次手术中同时治疗胆囊结石和胆总管结石以及术后住院时间较短。然而，需要更长的学习曲线。由经验丰富的外科医生为个体患者选择最合适的治疗方案能为患者带来最大益处。
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