Chander Jagdish, Mangla Vivek, Vindal Anubhav, Lal Pawanindra, Ramteke Vinod K
Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
J Laparoendosc Adv Surg Tech A. 2012 Jan-Feb;22(1):81-4. doi: 10.1089/lap.2011.0366. Epub 2011 Dec 6.
Patients with a dilated common bile duct (CBD) and multiple, primary, or recurrent stones are candidates for choledochoduodenostomy. This article reviews our technique and results of laparoscopic choledochoduodenostomy (LCDD) in patients with CBD stones.
Prospectively maintained data of patients with a dilated CBD and multiple, primary, or recurrent CBD stones who underwent LCDD after laparoscopic CBD exploration (LCBDE) at a tertiary-care teaching hospital in New Delhi, India, during a 10-year period from April 2001 to March 2011 were analyzed.
During this period, of 195 patients who underwent LCBDE for CBD stones, 27 patients underwent LCDD. The mean age of patients was 45.7±13.5 years. There were 6 male and 21 female patients. Sixteen (59.2%) patients had jaundice at presentation. Average CBD diameter was 19.6±4.4 mm. On average, 11.5±15.7 stones were removed from the CBD. Mean operative time was 156.3±25.4 minutes. Mean operative blood loss was 143.3±85.5 mL. Average postoperative hospital stay was 6.4±3.8 days. CBD clearance was obtained in all cases. One patient had a bile leak that resolved with conservative treatment. There was no mortality. No patient has had recurrence of symptoms or cholangitis after a follow-up of up to 9 years.
LCDD can be safely performed in patients with a large stone burden and recurrent or primary CBD stones. Although it requires advanced laparoscopic skills, the benefits of a single-stage laparoscopic procedure can be extended to these patients safely with good results.
胆总管扩张且伴有多发、原发性或复发性结石的患者适合行胆总管十二指肠吻合术。本文回顾了我们对胆总管结石患者行腹腔镜胆总管十二指肠吻合术（LCDD）的技术及结果。
对2001年4月至2011年3月期间，在印度新德里一家三级护理教学医院，因胆总管扩张且伴有多发、原发性或复发性胆总管结石，在腹腔镜胆总管探查术（LCBDE）后接受LCDD的患者的前瞻性维护数据进行分析。
在此期间，195例行LCBDE治疗胆总管结石的患者中，27例接受了LCDD。患者的平均年龄为45.7±13.5岁。男性6例，女性21例。16例（59.2%）患者就诊时伴有黄疸。胆总管平均直径为19.6±4.4mm。平均从胆总管取出11.5±15.7枚结石。平均手术时间为156.3±25.4分钟。平均术中失血量为143.3±85.5mL。术后平均住院时间为6.4±3.8天。所有病例均实现胆总管通畅。1例患者出现胆漏，经保守治疗后痊愈。无死亡病例。随访长达9年，无患者出现症状复发或胆管炎。
对于结石负荷大且有复发性或原发性胆总管结石的患者，可安全地进行LCDD。尽管该手术需要先进的腹腔镜技术，但单阶段腹腔镜手术的益处可安全地扩展至这些患者，且效果良好。
