Lei Jun, Wang Jun, Li Qiang, Wu Peng, Yuan Rongfa, Zhu Hengqing, Zou Shubing, Shao Jianghua, Fang Lu
Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
J Laparoendosc Adv Surg Tech A. 2016 Aug;26(8):646-51. doi: 10.1089/lap.2016.0004. Epub 2016 May 3.
Optimal laparoscopic techniques for management of gallstones concomitant with common bile duct (CBD) stones remain under debate. The aim of this study was to evaluate a novel approach to managing gallstones concomitant with large or impacted CBD stones through a modified laparoscopic transcystic CBD exploration (LTCBDE) with frequency-doubled double-pulse neodymium:YAG (FREDDY) laser lithotripsy.
This retrospective review includes 32 consecutive patients with gallstones concomitant with large or impacted CBD stones who were offered LTCBDE with FREDDY laser lithotripsy between June 2012 and December 2014. Demographic, perioperative, and follow-up data were collected and analyzed retrospectively.
CBD stone clearance was achieved for all patients. There were 13 males and 19 females, among whom there were three patients with a history of abdominal surgery. The diameter of the CBD ranged from 10 to 20 (mean 15.1) mm, and the number of CBD stones ranged from 1 to 5. CBD stones ranged in diameter from 9 to 18 (mean 11.7) mm and 9 patients had stones that were impacted in the CBD. The mean operative time was 123 ± 18 minutes with a range of 72 to 155 minutes. The mean length of postoperative hospital stay was 5.3 (range 4-7) days. All patients recovered normally without morbidity or mortality.
The modified LTCBDE with a T-shaped incision of the cystic duct and FREDDY laser lithotripsy is a safe and effective means of managing gallstones concomitant with large or impacted CBD stones.
对于合并胆总管（CBD）结石的胆囊结石，最佳的腹腔镜手术技术仍存在争议。本研究的目的是评估一种通过改良的腹腔镜经胆囊管胆总管探查术（LTCBDE）联合倍频双脉冲钕：钇铝石榴石（FREDDY）激光碎石术来处理合并大的或嵌顿性CBD结石的胆囊结石的新方法。
本回顾性研究纳入了2012年6月至2014年12月期间连续32例合并大的或嵌顿性CBD结石的胆囊结石患者，这些患者接受了LTCBDE联合FREDDY激光碎石术。回顾性收集并分析了患者的人口统计学、围手术期及随访数据。
所有患者的CBD结石均清除成功。其中男性13例，女性19例，有3例患者有腹部手术史。CBD直径为10至20（平均15.1）mm，CBD结石数量为1至5枚。CBD结石直径为9至18（平均11.7）mm，9例患者的结石嵌顿于CBD。平均手术时间为123±18分钟，范围为72至155分钟。术后平均住院时间为5.3（范围4至7）天。所有患者均正常康复，无并发症或死亡。
采用胆囊管T形切口的改良LTCBDE联合FREDDY激光碎石术是处理合并大的或嵌顿性CBD结石胆囊结石的一种安全有效的方法。
