Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
Surg Endosc. 2011 Jan;25(1):172-81. doi: 10.1007/s00464-010-1152-5. Epub 2010 Jun 10.
Common bile duct stones (CBDS) that are seen in the Asian population are very different from those seen in the west. It is not infrequent to see multiple, large, and impacted stones and a hugely dilated CBD. Many of these patients have been managed by open CBD exploration (OCBDE), even after the advent of laparoscopic cholecystectomy (LC), because these large stones pose significant challenges for extraction by endoscopic retrograde cholangiopancreatography. This series presents the largest experience of managing CBDS using a laparoscopic approach from Indian subcontinent.
Between 2003 and 2009, 150 patients with documented CBDS were treated laparoscopically at a tertiary care hospital in New Delhi. Of these, 4 patients were managed through transcystic route and 140 through the transcholedochal route.
There were 34 men and 116 women patients with age ranging from 15 to 72 years. The mean size of the CBD on ultrasound was 11.7 ± 3.7 mm and on MRCP 13.8 ± 4.7 mm. The number of stones extracted varied from 1 to 70 and the size of the extracted stones from 5 to 30 mm. The average duration of surgery was 139.9 ± 26.3 min and the mean intraoperative blood loss was 103.4 ± 85.9 ml. There were 6 conversions to open procedures, 1 postoperative death (0.7%), and 23 patients (15%) had nonfatal postoperative complications. Three patients had retained stones (2%) and one developed recurrent stone (0.7%).
Even in patients with multiple, large, and impacted CBDS, there is scope for a minimally invasive procedure with its attendant benefits in the form of laparoscopic CBD exploration (LCBDE).
在亚洲人群中常见的胆总管结石（CBDS）与在西方人群中常见的结石有很大的不同。经常可以看到多个、大的、嵌顿的结石和极度扩张的 CBD。由于这些大结石通过内镜逆行胰胆管造影（ERCP）提取具有很大的挑战性，许多此类患者已通过开腹胆总管探查术（OCBDE）进行了治疗，即使在腹腔镜胆囊切除术（LC）出现之后也是如此。本系列报道了来自印度次大陆使用腹腔镜方法治疗 CBDS 的最大经验。
2003 年至 2009 年，在新德里的一家三级护理医院，通过腹腔镜治疗了 150 例有 CBDS 记录的患者。其中，4 例通过经胆囊管途径治疗，140 例通过经胆总管途径治疗。
有 34 名男性和 116 名女性患者，年龄 15 至 72 岁。超声检查 CBD 的平均直径为 11.7 ± 3.7mm，磁共振胰胆管造影（MRCP）为 13.8 ± 4.7mm。取出的结石数量从 1 到 70 不等，取出的结石大小为 5 至 30mm。手术平均持续时间为 139.9 ± 26.3 分钟，术中平均失血量为 103.4 ± 85.9ml。有 6 例转为开腹手术，1 例术后死亡（0.7%），23 例（15%）发生非致命性术后并发症。3 例患者有残余结石（2%），1 例患者发生复发性结石（0.7%）。
即使在患有多个、大的、嵌顿性 CBDS 的患者中，也可以进行微创治疗，其具有腹腔镜胆总管探查术（LCBDE）的优势。
