Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGShu-jin , LINing , LIbei , HUhai-jie ,  CHENLi-ping

Department of Bile Duct Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

CHENLi-ping, Email: 47137417@qq.com

Keywords：

Cholecystolithiasis; Choledocholithiasis; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Elderly patient

DOI：

10.7507/1007-9424.20160369

Video：

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Objective To compare the effect of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients and non-elderly patients. Methods The clinical data of 185 cases of cholecystolithiasis combined with choledocholithiasis who treated in our hospital from September 2010 to November 2015 were analyzed retrospectively. Then the 185 cases of holecystolithiasis combined with choledocholithiasis were divided into elderly patients group (n=74) and the non-elderly patients group (n=111). The operative time, intraoperative blood loss, postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, incidence of complications, unplanned analgesia, stone-free rate, rate of conversion to laparotomy, recurrence of stone, and mortality were compared between the two groups. Results ① Intraoperative and postoperative indexes. No significant difference was noted in operative time and intraoperative blood loss (P > 0.050), but the postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, and ratio of indwelling T tube of elderly patients group were all higher or longer than corresponding index of non-elderly patients group (P < 0.050). ② Postoperative complications and unplanned analgesia. There was no striking discrepancy in incidence of complications (including biliary leakage, peritonitis, haemorrhage, vomit, ectoralgia, and fever), and Clavien-Dindo grade (P > 0.050), except unplanned analgesia (P=0.007), the rate of unplanned analgesia in elderly patients group was higher than that of non-elderly patients group. ③Surgical effect. There was no significant difference in the stone-free rate, rate of conversion to laparotomy, and rate of recurrence of stone between the 2 groups (P > 0.050). Conclusion LC+LCBDE is also safe and effective in treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients, it's worthy to be expanded and be used broadly.

Citation： WANGShu-jin, LINing, LIbei, HUhai-jie, CHENLi-ping. Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1455-1459. doi: 10.7507/1007-9424.20160369 Copy

1.	Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients:as a first treatment strategy for common bile duct stones. J Korean Surg Soc, 2011, 81(2):128-133.
2.	范彦, 吴杰, 黄晓东, 等.老年胆总管结石内镜下治疗特殊性的临床分析.中华肝胆外科杂志, 2011, 17(9):781-783.
3.	陈盛, 郑江华, 区应亮, 等.两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较.中国普外基础与临床杂志, 2012, 19(11):1213-1217.
4.	Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term term results of laparoscopic common bile duct exploration. Surg Endosc, 2003, 17(1):19-22.
5.	Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystec-tomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial. Surg Endosc, 2014, 28(3):875-885.
6.	Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single center. Ann Surg Treat Res, 2014, 86(1):1-6.
7.	顾大男.老年人年龄界定和重新界定的思考.中国人口科学, 2000, (3):42-51.
8.	Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures:analysis of 2010 to 2012. J Urol, 2013, 190(4):1271-1274.
9.	Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
10.	石景森, 王炳煌.胆道外科基础与临床.北京:人民卫生出版社, 2003:497.
11.	张煜.肝胆管结石的外科治疗.中外医疗, 2011, 30(30):90.
12.	李相哲.普外科肝胆结石病46例患者的临床分析.中国医药指南, 2013, 11(26):464-467.
13.	赵冬雨, 成丽娅, 于健.胆囊结石继发胆总管结石不同手术方式的临床疗效分析.中国普外基础与临床杂志, 2014, 21(4):498-500.
14.	Costi R, Gnocchi A, Di Mario F, et al. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol, 2014, 20(37):13382-13401.
15.	张乐, 白月奎, 欧云菘, 等.腹腔镜胆囊切除胆道探查术治疗胆囊结石合并胆总管结石的临床观察.中国普通外科杂志, 2014, 23(8):1141-1143.
16.	Kim SB, Kim KH, Kim TN. Comparison of outcomes and complications of endoscopic common bile duct stone removal between asymptomatic and symptomatic patients. Dig Dis Sci, 2016, 61(4):1172-1177.
17.	王中魁, 赵海鹰, 刘金钢, 等.老年人胆囊结石合并胆总管结石术式选择探讨(附60例报告).中国实用外科杂志, 2015, 27(4):448-450.
18.	吴文广, 王雪峰. ERCP相关胰腺及十二指肠损伤特点及外科治疗.中国实用外科杂志, 2015, 35(3):327-329.
19.	李宇, 郝杰, 孙昊, 等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较.中国普通外科杂志, 2016, 25(2):202-208.
20.	Cuschieri A, Lezoche E, Mornino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc, 1999, 13(10):952-957.
21.	Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancrea-tography plus laparoscopic cholecystectomy for choledocholithiasis:a prospective randomized study. Am J Surg, 2013, 206(4):457-463.
22.	菅志远, 沈先锋, 黄林生, 等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析.中国普通外科杂志, 2015, 24(2):275-279.
23.	赵冬雨, 成丽娅, 沈宏, 等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用研究.中国普外基础与临床杂志, 2013, 20(7):793-796.
24.	Kenny R, Richardson J, McGlone ER, et al. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy:is there any difference. Int J Surg, 2014, 12(9):989-993.
25.	孙学军, 卢乐, 石景森.肝胆管结石的微创外科治疗进展.中国普外基础与临床杂志, 2006, 13(4):403-405.
26.	Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
27.	钟伟, 倪谢根.腹腔镜联合纤维胆道镜与开腹手术治疗老年胆总管结石对术后疼痛及胃肠功能的影响.中国普通外科杂志, 2015, 24(2):280-283.

1. Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients:as a first treatment strategy for common bile duct stones. J Korean Surg Soc, 2011, 81(2):128-133.
2. 范彦, 吴杰, 黄晓东, 等.老年胆总管结石内镜下治疗特殊性的临床分析.中华肝胆外科杂志, 2011, 17(9):781-783.
3. 陈盛, 郑江华, 区应亮, 等.两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较.中国普外基础与临床杂志, 2012, 19(11):1213-1217.
4. Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term term results of laparoscopic common bile duct exploration. Surg Endosc, 2003, 17(1):19-22.
5. Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystec-tomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial. Surg Endosc, 2014, 28(3):875-885.
6. Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single center. Ann Surg Treat Res, 2014, 86(1):1-6.
7. 顾大男.老年人年龄界定和重新界定的思考.中国人口科学, 2000, (3):42-51.
8. Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures:analysis of 2010 to 2012. J Urol, 2013, 190(4):1271-1274.
9. Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
10. 石景森, 王炳煌.胆道外科基础与临床.北京:人民卫生出版社, 2003:497.
11. 张煜.肝胆管结石的外科治疗.中外医疗, 2011, 30(30):90.
12. 李相哲.普外科肝胆结石病46例患者的临床分析.中国医药指南, 2013, 11(26):464-467.
13. 赵冬雨, 成丽娅, 于健.胆囊结石继发胆总管结石不同手术方式的临床疗效分析.中国普外基础与临床杂志, 2014, 21(4):498-500.
14. Costi R, Gnocchi A, Di Mario F, et al. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol, 2014, 20(37):13382-13401.
15. 张乐, 白月奎, 欧云菘, 等.腹腔镜胆囊切除胆道探查术治疗胆囊结石合并胆总管结石的临床观察.中国普通外科杂志, 2014, 23(8):1141-1143.
16. Kim SB, Kim KH, Kim TN. Comparison of outcomes and complications of endoscopic common bile duct stone removal between asymptomatic and symptomatic patients. Dig Dis Sci, 2016, 61(4):1172-1177.
17. 王中魁, 赵海鹰, 刘金钢, 等.老年人胆囊结石合并胆总管结石术式选择探讨(附60例报告).中国实用外科杂志, 2015, 27(4):448-450.
18. 吴文广, 王雪峰. ERCP相关胰腺及十二指肠损伤特点及外科治疗.中国实用外科杂志, 2015, 35(3):327-329.
19. 李宇, 郝杰, 孙昊, 等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较.中国普通外科杂志, 2016, 25(2):202-208.
20. Cuschieri A, Lezoche E, Mornino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc, 1999, 13(10):952-957.
21. Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancrea-tography plus laparoscopic cholecystectomy for choledocholithiasis:a prospective randomized study. Am J Surg, 2013, 206(4):457-463.
22. 菅志远, 沈先锋, 黄林生, 等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析.中国普通外科杂志, 2015, 24(2):275-279.
23. 赵冬雨, 成丽娅, 沈宏, 等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用研究.中国普外基础与临床杂志, 2013, 20(7):793-796.
24. Kenny R, Richardson J, McGlone ER, et al. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy:is there any difference. Int J Surg, 2014, 12(9):989-993.
25. 孙学军, 卢乐, 石景森.肝胆管结石的微创外科治疗进展.中国普外基础与临床杂志, 2006, 13(4):403-405.
26. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
27. 钟伟, 倪谢根.腹腔镜联合纤维胆道镜与开腹手术治疗老年胆总管结石对术后疼痛及胃肠功能的影响.中国普通外科杂志, 2015, 24(2):280-283.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis

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