Liu Wen-Song, Zou Yan, Yang Bo, Jiang Yong, Sun Dong-Lin
Am Surg. 2017 Dec 1;83(12):1343-1346.
Conventionally, patients suffered from recurrent common bile duct (CBD) stone after cholecystectomy are suggested to be treated with endoscopic retrograde cholangiopancreaticography. This study was designed to explore the feasibility of laparoscopic common bile duct exploration (LCBDE) as a salvage procedure for recurrent CBD calculi after cholecystectomy. A retrospective review was conducted of data from 65 patients who underwent LCBDE for recurrent CBD calculi after cholecystectomy from January 2011 to July 2015. LCBDE was successfully carried out in 61 cases, with a successful rate of 93.8 per cent. Three cases required open conversion because of serious abdominal adhesion, and one case for intraoperative bleeding. Postoperative bile leakage occurred in two cases, and bile peritonitis developed in one case; all these three patients with complications were fully cured by conservative treatment. A postoperative retained CBD stone was found in one patient, which was extracted with endoscopic sphincterotomy. Furthermore, it was found that the mean operative time and length of postoperative hospital stay were much shorter in primary closure group (n = 49) than in T-tube drainage group (n = 12), and the hospital expense was also lower in primary closure group. We suggest that LCBDE could be a novel approach as a salvage procedure for the recurrent CBD stone after cholecystectomy, and we prefer to intraoperative primary closure of CBD if possible.
传统上，胆囊切除术后患有复发性胆总管结石的患者建议接受内镜逆行胰胆管造影术治疗。本研究旨在探讨腹腔镜胆总管探查术（LCBDE）作为胆囊切除术后复发性胆总管结石补救手术的可行性。对2011年1月至2015年7月期间因复发性胆总管结石接受LCBDE的65例患者的数据进行了回顾性分析。61例患者成功实施了LCBDE，成功率为93.8%。3例因严重腹腔粘连需要中转开腹，1例因术中出血中转开腹。2例发生术后胆漏，1例发生胆汁性腹膜炎；所有这3例并发症患者均经保守治疗完全治愈。1例患者术后发现胆总管残留结石，通过内镜括约肌切开术取出。此外，发现一期缝合组（n = 49）的平均手术时间和术后住院时间比T管引流组（n = 12）短得多，一期缝合组的住院费用也更低。我们认为LCBDE可以作为胆囊切除术后复发性胆总管结石补救手术的一种新方法，并且如果可能的话，我们更倾向于术中对胆总管进行一期缝合。
