Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 100853, Beijing, China.
Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 100853, Beijing, China.
Am J Surg. 2018 Apr;215(4):631-635. doi: 10.1016/j.amjsurg.2017.05.020. Epub 2017 Jun 16.
Although laparoscopic transcystic common bile duct exploration (LTCBDE) is the preferred approach for CBD stone clearance, the success rate can vary between 55% and 85%. This study evaluated if ultrathin choledochoscope and holmium laser lithotripsy could improve the success rate of LTCBDE.
Records of 126 patients (average age, 46.1 ± 13.8 years) with cholecystocholedocholithiasis treated with laparoscopic cholecystectomy (LC) and LTCBDE were retrospectively reviewed.
LC+LTCBDE was performed successfully in 118 of 126 patients, with a surgical success rate of 93.7%. An ultrathin choledochoscope was used in 75 (63.5%) patients, and holmium lithotripsy was performed in 38 (32.2%) patients. The stone clearance rate was 99.2% (117/118). No significant complications occurred. One hundred (84.7%) patients had excellent and 13 (11%) had good outcomes for an overall success rate (excellent plus good) of 95.7%.
Ultrathin choledochoscope and holmium laser lithotripsy can improve the surgical outcomes of LC+LTCBDE with minimal complications.
虽然腹腔镜经胆囊管胆总管探查术（LTCBDE）是清除胆总管结石的首选方法，但成功率在 55%至 85%之间有所不同。本研究评估了超细胆道镜和钬激光碎石术是否可以提高 LTCBDE 的成功率。
回顾性分析了 126 例胆囊结石合并胆总管结石患者（平均年龄 46.1±13.8 岁）接受腹腔镜胆囊切除术（LC）和 LTCBDE 的治疗记录。
126 例患者中 118 例成功完成 LC+LTCBDE，手术成功率为 93.7%。75 例患者使用超细胆道镜，38 例患者行钬激光碎石术。结石清除率为 99.2%（117/118）。无明显并发症发生。100 例（84.7%）患者术后效果极佳，13 例（11%）患者术后效果良好，总体成功率（极佳加良好）为 95.7%。
超细胆道镜和钬激光碎石术可以提高 LC+LTCBDE 的手术效果，且并发症发生率低。
