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经皮经胆管引流管胆道镜下行腹腔镜胆总管切开术治疗肝内胆管结石和胆总管结石的疗效:越南的一项初步研究。

Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study.

作者信息

Le Loi Van, Vu Quang Van, Le Thanh Van, Le Hieu Trung, Dang Khue Kim, Vu Tuan Ngoc, Nguyen Anh Hoang Ngoc, Tran Thang Manh

机构信息

Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam.

College of Health Sciences, VinUniversity, Hanoi, Vietnam.

出版信息

Ann Hepatobiliary Pancreat Surg. 2024 Feb 29;28(1):42-47. doi: 10.14701/ahbps.23-085. Epub 2023 Dec 20.


DOI:10.14701/ahbps.23-085
PMID:38114078
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10896692/
Abstract

BACKGROUNDS/AIMS: Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. METHODS: A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. RESULTS: A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. CONCLUSIONS: Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

摘要

背景/目的:肝内胆管结石和胆总管结石是常见病症,遗憾的是,按照当前的治疗策略,复发率仍然很高。本研究旨在评估经皮经肝胆管置管胆道镜下腹腔镜胆总管切开术治疗越南患者肝内胆管结石和胆总管结石的疗效。 方法:对2017年6月至2020年3月在108军事中心医院肝胆胰外科接受经皮经肝胆管置管术中胆道镜下腹腔镜胆总管切开术的肝内胆管结石和/或胆总管结石患者进行横断面研究。 结果:共分析了84例患者。大多数患者为女性(56.0%),中位年龄为55.56岁。其中,41.8%的患者既往有腹部手术史,33.4%的患者曾行胆总管切开术。所有患者均成功进行了腹腔镜胆总管探查并留置T管引流,无需转为开放手术。大多数患者(64.3%)同时有肝内和肝外结石。直径≥10 mm的结石发生率为64.3%。胆道镜检查时,19.1%的患者发现胆管狭窄。54.8%的患者结石完全清除。两名患者出现术中并发症,但无需改变治疗策略。平均手术时间为121.85±30.47分钟。术后早期并发症发生率为9.6%,所有患者均经保守治疗。34/38例患者通过后续的经T管胆道镜检查经T管窦道清除了残留结石,因此总成功率为95.2%。 结论:经皮经肝胆管置管胆道镜下腹腔镜胆总管切开术治疗肝内胆管结石和/或胆总管结石是一种安全有效的策略,即使是既往有胆总管切开术的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/28c6df244df3/ahbps-28-1-42-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/05bcfde6535c/ahbps-28-1-42-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/4b34e50f9afe/ahbps-28-1-42-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/28c6df244df3/ahbps-28-1-42-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/05bcfde6535c/ahbps-28-1-42-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/4b34e50f9afe/ahbps-28-1-42-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31e6/10896692/28c6df244df3/ahbps-28-1-42-f3.jpg

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本文引用的文献

[1]
Surgical Management of Recurrence of Primary Intrahepatic Bile Duct Stones.

Can J Gastroenterol Hepatol. 2023

[2]
Long-Term Outcomes of Laparoscopic Common Bile Duct Exploration Through Diathermy, Choledochotomy, and Primary Closure: A 6-Year Retrospective Cohort Study.

J Laparoendosc Adv Surg Tech A. 2023-3

[3]
The safety and feasibility of laparoscopic approach for the management of intrahepatic and extrahepatic bile duct stones in patients with prior biliary tract surgical interventions.

Sci Rep. 2022-8-25

[4]
Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones.

Surg Endosc. 2022-7

[5]
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Hepatobiliary Pancreat Dis Int. 2021-8

[6]
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Turk J Surg. 2020-12-29

[7]
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Int J Med Sci. 2021

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World J Clin Cases. 2019-5-6

[9]
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