Zhang L F, Hou C S, Huang Y H, Xu Z, Wang L X, Ling X F, Wang G, Cui L, Xiu D R
Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Apr 18;51(2):345-348. doi: 10.19723/j.issn.1671-167X.2019.02.027.
To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy.
Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed.
Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth II in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment.
Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.
探讨腹腔镜和内镜治疗胃切除术后胃空肠吻合患者胆总管结石的可行性，并比较两者的优缺点。
2012年1月至2016年12月，25例胃切除术后胃空肠吻合并发胆总管结石患者在我院接受腹腔镜或内镜治疗。根据胆总管结石治疗方式分为腹腔镜组和内镜组，腹腔镜组15例，内镜组10例。回顾性分析两组患者的临床特征及治疗结果。
25例胃空肠吻合患者中，胃重建方式为毕Ⅱ式21例，Roux-en-Y式4例。6例患者在急性胆管炎状态下接受腹腔镜或内镜治疗。腹腔镜组中，结石直径大于1 cm者5例，多发结石者7例；内镜组中，结石直径大于1 cm者3例，多发结石者4例。腹腔镜组14例合并胆囊结石，其中6例胆总管结石经胆囊途径成功取出，未放置T管引流。内镜组4例患者一次手术成功取石，其中3例为单个小结石，1例为多个小结石。腹腔镜组2例因粘连严重中转开腹手术，内镜组1例因Roux-en-Y吻合状态下未找到乳头而转为腹腔镜手术。腹腔镜组和内镜组患者术后中位住院时间分别为12天和10天。术后并发症3例，腹腔镜组1例麻痹性肠梗阻，内镜组2例胆源性胰腺炎或菌血症，经保守治疗均痊愈。
腹腔镜和内镜治疗胃切除术后胃空肠吻合患者胆总管结石均可行，且两者相互补充。此外，两种技术操作难度均较大，选择治疗方式时应考虑技术熟练程度。
