Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing City, China.
Surg Laparosc Endosc Percutan Tech. 2023 Feb 1;33(1):62-68. doi: 10.1097/SLE.0000000000001135.
Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP).
Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n=56) and a remote LC group (group B, n=29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B.Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals.Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups.
In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter ( P <0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group ( P <0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter ( P <0.05).
This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.
胆总管（CBD）的测量是评估胆道系统的一个关键方面。腹腔镜胆囊切除术或腹腔镜胆总管探查术后 CBD 直径是否会发生代偿性变化仍存在争议。本研究旨在通过磁共振胰胆管成像（MRCP）研究腹腔镜胆囊切除术（LC）和腹腔镜胆总管探查术（LCBDE）后 CBD 直径的变化。
我们的回顾性研究分为两部分。第一部分评估了因胆囊结石或胆囊息肉而接受 LC 后 CBD 直径的变化，共纳入 85 例接受 MRCP 检查的患者。这些年龄在 30 至 85 岁之间的患者分为间隔 LC 组（A 组，n=56）和远程 LC 组（B 组，n=29）。在 A 组中，在术前和术后 MRCP 上测量 CBD 最宽处的直径。在 B 组中，在手术后两次获得的 MRCP 上重复测量 CBD 直径。第二部分包括 38 例患有胆总管结石并接受腹腔镜胆总管探查和 T 管放置的患者。这些年龄在 26 至 86 岁之间的患者形成间隔 LCBDE 组（C 组）。在这些患者中，在 LCBDE 前和 T 管胆管造影后测量 CBD 最宽直径。A 组和 C 组的患者进一步分为 5 组，B 组分为 4 组，以方便统计分析。在 A 组和 B 组中，使用 Pearson 相关检验来寻找 CBD 直径与年龄之间的关系。使用配对样本 T 检验比较每组和各亚组之间两组 CBD 直径的显著差异。
在间隔 LC 组中，LC 后平均 CBD 直径明显大于术前平均直径（P<0.05）。在远程 LC 组中，第一次和第二次 LC 后 CBD 直径的平均值之间存在显著差异（P<0.05）。在 C 组中，LCBDE 后 T 管胆管造影测量的平均 CBD 直径明显小于术前扩张的平均直径（P<0.05）。
本研究表明腹腔镜胆囊切除术后 CBD 直径显著扩张。此外，我们的远程 LC 组也通过显示第一次和第二次 LC 后 CBD 直径值之间的显著扩张来支持这一说法。最后，我们的间隔 LCBDE 样本的 CBD 直径在手术后和结石取出后初始扩张减少。
