Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Ann Palliat Med. 2021 Dec;10(12):12845-12856. doi: 10.21037/apm-21-3609.
Laparoscopic transcystic common bile duct exploration (LTCBDE) is the minimally traumatic surgical method for the treatment of choledocholithiasis secondary to cholecystolithiasis with dilated common bile duct (CBD). However, no report exists concerning LTCBDE in patients with nondilated CBD. The purpose of this study was thus to explore the safety, efficacy, and feasibility of LTCBDE in patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD.
We retrospectively analyzed 47 patients with choledocholithiasis secondary to cholecystolithiasis who were treated with LTCBDE at the Second Affiliated Hospital of Nanchang University from January 2017 to August 2021 (all the patients had undergone endoscopic retrograde cholangio-pancreatography treatment, but this failed due to various reasons). Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction, and surgical outcomes were collected and reviewed. Each patient was followed up for more than 3 months.
There were 47 patients in this study, including 21 females and 26 males, with their ages ranging from 15 to 82 years (51±15 years). All patients were treated with surgery, and the CBD stones were removed successfully. Among these patients, 45 underwent LTCBDE for the removal of stones in the CBD, with failure occurring in 2 patients who then accepted laparoscopic common bile duct stone removal (LCBDE) + T tube drainage. The diameter of the cystic duct was 0.30-0.73 cm (0.60±0.07 cm), the diameter of the CBD was 0.60-0.80 cm (0.73±0.05 cm), the operation time was 75-220 minutes (159±33 minutes), and the postoperative hospital stay was 2-13 days (6±2 days). None of the patients experience any serious postoperative complications, and all were discharged safely. During the follow-up, no postoperative biliary stenosis, bile leakage, or other complications occurred.
LTCBDE is feasible to treat patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD. This choice of treatment plan reduces the length of hospital stay and the occurrence of postoperative complications. However, it is recommended that this be attempted on the basis of the experience of LTCBDE with dilated CBD.
腹腔镜经胆囊管胆总管探查术（LTCBDE）是治疗胆囊结石合并胆总管扩张的胆石症的微创外科方法。然而，对于胆总管不扩张的胆石症患者，尚无 LTCBDE 的相关报道。因此，本研究旨在探讨 LTCBDE 治疗胆囊结石合并胆总管不扩张的胆石症的安全性、有效性和可行性。
我们回顾性分析了 2017 年 1 月至 2021 年 8 月南昌大学第二附属医院收治的 47 例因胆囊结石合并胆总管结石行 LTCBDE 治疗的患者（所有患者均接受过内镜逆行胰胆管造影治疗，但由于各种原因未能成功）。收集并回顾了疾病特征、胆囊管切开和胆总管结石取出方法及手术结果的临床资料。每位患者的随访时间均超过 3 个月。
本研究共纳入 47 例患者，其中女性 21 例，男性 26 例，年龄 15-82 岁（51±15 岁）。所有患者均接受手术治疗，成功取出胆总管结石。其中 45 例患者行 LTCBDE 取石治疗，2 例患者因结石嵌顿改行腹腔镜胆总管切开取石术+T 管引流。胆囊管直径 0.30-0.73cm（0.60±0.07cm），胆总管直径 0.60-0.80cm（0.73±0.05cm），手术时间 75-220min（159±33min），术后住院时间 2-13d（6±2d）。无严重术后并发症发生，患者均安全出院。随访期间，无术后胆道狭窄、胆漏等并发症发生。
LTCBDE 治疗胆总管不扩张的胆囊结石合并胆总管结石是可行的，该治疗方案可缩短住院时间，减少术后并发症的发生。但建议在有胆总管扩张 LTCBDE 经验的基础上尝试该治疗方案。
