Gui Liang, Liu Ye, Qin Jun, Zheng Lei, Huang Yi-Jun, He Yue, Deng Wen-Sheng, Qian Bin-Bin, Luo Meng
1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
2 Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
J Laparoendosc Adv Surg Tech A. 2016 Dec;26(12):972-977. doi: 10.1089/lap.2016.0308. Epub 2016 Aug 10.
To evaluate the safety and benefits of laparoscopic common bile duct exploration (LCBDE) compared with open approach (OCBDE) in cirrhotic patients.
Between January 2009 and December 2012, a total of 113 cirrhotic patients with choledocholithiasis underwent common bile duct (CBD) explorations in our department. There were two groups of patients: A:LCBDE (n = 61) and B:OCBDE (n = 52). Patients' demographic characteristics, surgical data, postoperative outcomes, and long-term results were retrospectively collected and analyzed.
There were no significant differences between the two groups in the demographic characteristics or preoperative status. The transcystic approach was successfully performed in 52 (46.0%) patients (group A:34, group B:20), whereas choledochotomy was successful in 59 (54.0%) patients (group A:27, group B:32). The differences between group A and group B in terms of surgical time (124.9 ± 34.2 minutes versus 132.6 ± 48.6 minutes, P = .323), stone clearance rate (93.4% versus 94.2%, P > .05), short-term complication rate (9.8% versus 13.4%, P = .547), and recurrent stone rate (6.6% versus 5.8%, P > .05) were not statistically significant. However, group A suffered less blood loss [95 (60-200) mL versus 200 (90-450) mL, P < .001] and shorter length of hospital stay (4.7 ± 2.5 days versus 11.3 ± 3.1 days, P < .001) than group B. In the LCBDE group, 4 (6.6%) patients were converted due to heavy inflammation and severe adhesions. No mortality, biliary injury, or stricture occurred during follow-up.
LCBDE can be safely performed in patients with Child-Pugh A or B cirrhosis and choledocholithiasis, with considerable efficiency, minimal short-term complications, and acceptable long-term outcomes. LCBDE has the advantages over open CBD exploration of less bleeding and reduced length of hospital stay.
评估腹腔镜胆总管探查术（LCBDE）与开腹手术（OCBDE）相比，在肝硬化患者中的安全性和益处。
2009年1月至2012年12月期间，共有113例患有胆总管结石的肝硬化患者在我科接受了胆总管探查术。患者分为两组：A组：LCBDE（n = 61）和B组：OCBDE（n = 52）。回顾性收集并分析患者的人口统计学特征、手术数据、术后结果和长期结果。
两组在人口统计学特征或术前状态方面无显著差异。52例（46.0%）患者成功实施了经胆囊途径（A组：34例，B组：20例），而59例（54.0%）患者成功实施了胆总管切开术（A组：27例，B组：32例）。A组和B组在手术时间（124.9±34.2分钟对132.6±48.6分钟，P = 0.323）、结石清除率（93.4%对94.2%，P>0.05）、短期并发症发生率（9.8%对13.4%，P = 0.547）和结石复发率（6.6%对5.8%，P>0.05）方面无统计学显著差异。然而，A组的失血量[95（60 - 200）mL对200（90 - 450）mL，P<0.001]和住院时间（4.7±2.5天对11.3±3.1天，P<0.001）均少于B组。在LCBDE组中，4例（6.6%）患者因炎症严重和粘连严重而中转手术。随访期间未发生死亡、胆管损伤或狭窄。
LCBDE可安全地应用于Child-Pugh A或B级肝硬化合并胆总管结石的患者，具有较高的效率、极少的短期并发症和可接受的长期预后。与开腹胆总管探查术相比，LCBDE具有出血少和住院时间缩短的优点。
