Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK.
Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
Surg Endosc. 2021 Nov;35(11):6268-6277. doi: 10.1007/s00464-020-08127-w. Epub 2020 Nov 2.
The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt.
We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes.
We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture.
Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients.
随着诊断影像学和治疗技术的发展，胆总管结石的治疗方法也在不断发展，腹腔镜技术得到了广泛应用。我们回顾了 200 例腹腔镜胆总管探查术的病例，重点介绍了遇到的挑战和经验教训。
我们回顾性研究了 2006 年至 2019 年期间 200 例腹腔镜胆囊切除术联合胆总管探查术的病例。数据库包含了患者的人口统计学、临床病理学特征、诊断方法、手术技术、手术时间和结果。
我们比较了两种方法：经胆囊管和经胆总管。术前怀疑胆总管结石 163 例。21 例未发现结石。其余患者中，111/179 例经经胆囊管途径完成，其余 68/179 例经胆总管完成；25%的胆总管病例是由经胆囊管途径中转完成的。经胆囊管途径的胆总管直径为 8.2mm，经胆总管途径为 11.0mm。总清除率为 84%。7 例患者有残留或复发结石。住院时间为 5.8 天，经胆囊管途径为 3.5 天，经胆总管途径为 9.4 天。8 例患者因出血或胆漏需要再次手术。本队列无死亡病例，但有 2 例（1%）发生后续胆总管狭窄。
在地区综合医院，腹腔镜胆总管探查术联合胆囊切除术是可行、安全、有效的，尽管受到时间和资源的限制。经胆囊管途径并发症发生率较低，住院时间较短，因此我们优先选择该途径治疗所有病例。结石处理技术的进步将使更多患者受益于这种技术的广泛应用。
