Department of Endoscopy, the First Affiliated Hospital of Shandong First Medical, University, 250014, Jinan, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shandong First Medical University, 250014, Jinan, China.
Surg Endosc. 2021 Jul;35(7):3723-3731. doi: 10.1007/s00464-020-07862-4. Epub 2020 Aug 11.
Laparoscopic common bile duct exploration (LCBDE) is the first choice of treatment for large common bile duct (CBD) stones. Recently, single-operator cholangioscopy (SpyGlass system) has been introduced widely in referral and large medical centers. Several studies have reported favorable results for treatment of large CBD stones guided by SpyGlass. We evaluated the clinical efficacy and safety of SpyGlass-guided laser lithotripsy LCBDE for treatment of large CBD stones.
From August 2015 to August 2018, 157 patients with large bile duct stones who met the inclusion criteria were randomly divided into two groups: SpyGlass-guided laser lithotripsy (Group A) and LCBDE (Group B). The efficacy and complications were compared between the groups.
Although the first-session stone removal rate in Group A was significantly lower than that in Group B, Group A was not inferior to Group B in terms of total stone removal rate. Compared with Group B, Group A had shorter hospital stay and enhanced recovery. The short-term complication rates were also similar between the two groups.
The clinical efficacy of SpyGlass-guided laser lithotripsy for the treatment of large CBD stones is not inferior to that of LCBDE, and it is less invasive. SpyGlass-guided laser lithotripsy is an important option for treatment of large CBD stones.
腹腔镜胆总管探查术（LCBDE）是治疗胆总管（CBD）大结石的首选方法。最近，单操作孔胆管镜（SpyGlass 系统）在转诊和大型医疗中心得到了广泛应用。几项研究报告了 SpyGlass 引导下治疗大 CBD 结石的良好结果。我们评估了 SpyGlass 引导下激光碎石 LCBDE 治疗大 CBD 结石的临床疗效和安全性。
2015 年 8 月至 2018 年 8 月，符合纳入标准的 157 例大胆管结石患者被随机分为两组：SpyGlass 引导下激光碎石组（A 组）和 LCBDE 组（B 组）。比较两组的疗效和并发症。
虽然 A 组首次取石率明显低于 B 组，但总取石率 A 组并不逊于 B 组。与 B 组相比，A 组住院时间更短，恢复更快。两组短期并发症发生率也相似。
SpyGlass 引导下激光碎石治疗大 CBD 结石的临床疗效不亚于 LCBDE，且创伤更小。SpyGlass 引导下激光碎石是治疗大 CBD 结石的重要选择。
