Huang Jian, Hu Wei, Liu Jinghang, Tang Xinguo, Fan Yuting, Xu Liangzhi, Liu Tiande, Xiong Hu, Li Wen, Fu Xiaowei, Liang Bo, Fang Lu
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
J Gastrointest Surg. 2023 Mar;27(3):555-564. doi: 10.1007/s11605-023-05594-z. Epub 2023 Jan 18.
Laparoscopic transcystic common bile duct exploration (LTCBDE) is used to treat cholecystolithiasis and choledocholithiasis. This study aimed to investigate the safety, effectiveness and generalisability of LTCBDE in patients with cholecystolithiasis and choledocholithiasis based on our LTCBDE experience within 8 years.
Four hundred patients with cholecystolithiasis and choledocholithiasis (including 62 of cholecystolithiasis and choledocholithiasis with common bile duct no-dilatation) treated with LTCBDE at a single centre from January 2014 to February 2022 were retrospectively evaluated. They were divided into the first 200 and last 200 LTCBDE cases. The disease characteristics, cystic duct incision methods, surgical outcomes and follow-up data were analysed retrospectively. Each patient was followed up for > 3 months.
Four hundred patients underwent LTCBDE, including 188 males and 212 females aged from 15 to 91 years (average age: 56 years). LTCBDE was successful in 377 (94.3%) patients, while treatment was converted to laparoscopic choledocholithotomy with T-tube drainage in 23 (5.8%), owing to intraoperative choledochoscope insertion failure. The CBD diameter (10.89 ± 1.76 vs 9.97 ± 2.39, P < 0.05), cystic duct diameter (4.62 ± 1.03 vs 5.03 ± 1.29, P < 0.05), and operation time (164.60 ± 24.30 vs 135.34 ± 30.00, P < 0.05). Residual stones were found in six (1.5%) patients and removed during the second operation; post-operative bile leakage was found in one (0.3%) patient, who was discharged safely after the second operation.
Phase I LTCBDE is safe and effective in treating cholecystolithiasis and choledocholithiasis. With continuous technological advances, LTCBDE has been effectively promoted and applied.
腹腔镜经胆囊管胆总管探查术（LTCBDE）用于治疗胆囊结石和胆总管结石。本研究旨在基于我们8年的LTCBDE经验，探讨LTCBDE治疗胆囊结石和胆总管结石患者的安全性、有效性和可推广性。
回顾性评估2014年1月至2022年2月在单一中心接受LTCBDE治疗的400例胆囊结石和胆总管结石患者（包括62例胆总管无扩张的胆囊结石和胆总管结石患者）。他们被分为前200例和后200例LTCBDE病例。对疾病特征、胆囊管切开方法、手术结果和随访数据进行回顾性分析。每位患者随访时间均超过3个月。
400例患者接受了LTCBDE，其中男性188例，女性212例，年龄15至91岁（平均年龄：56岁）。377例（94.3%）患者LTCBDE手术成功，23例（5.8%）因术中胆道镜插入失败，转为腹腔镜胆总管切开取石T管引流术。胆总管直径（10.89±1.76 vs 9.97±2.39，P<0.05）、胆囊管直径（4.62±1.03 vs 5.03±1.29，P<0.05）和手术时间（164.60±24.30 vs 135.34±30.00，P<0.05）。6例（1.5%）患者发现残留结石，在二次手术中取出；1例（0.3%）患者术后发生胆漏，二次手术后安全出院。
I期LTCBDE治疗胆囊结石和胆总管结石安全有效。随着技术的不断进步，LTCBDE得到了有效推广和应用。
