Clinical analysis of laparoscopic common bile duct reexploration in treatment of bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Li ¹ , CHEN Xianxiang ² , YANG Rui ² , ZENG Tiancai ² ,  WANG Weixing ¹

1. Department of Hepatobiliary & Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;
2. Department of Hepatobiliary & Pancreatic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China;

Corresponding author：

WANG Weixing, Email: sate.llite@163.com

Keywords：

laparoscopic operation; laparotomy; bile duct stone; biliary reoperation

DOI：

10.7507/1007-9424.201707081

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Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.

Citation： YAO Li, CHEN Xianxiang, YANG Rui, ZENG Tiancai, WANG Weixing. Clinical analysis of laparoscopic common bile duct reexploration in treatment of bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(1): 54-58. doi: 10.7507/1007-9424.201707081 Copy

1.	张道建, 沈盛, 倪晓凌, 等. 肝胆管结石术后结石残留及复发诊治进展. 中国实用外科杂志, 2016, 36(3): 333-336.
2.	Tian J, Li JW, Chen J, et al. Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases. Dig Liver Dis, 2013, 45(6): 493-498.
3.	龚连生, 张阳德, 刘恕, 等. 胆道术后腹腔镜再次手术. 中国内镜杂志, 2004, 10(10): 3-5.
4.	张楷, 詹峰, 张云, 等. 腹腔镜再次胆道手术治疗胆总管结石. 中华肝胆外科杂志, 2014, 20(4): 265-268.
5.	Li L B, Cai X J, Mou Y P, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases. World J Gastroenterol, 2008, 14(19): 3081-3084.
6.	中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜治疗肝胆管结石病的专家共识(2013版). 中华消化外科杂志, 2013, 12(1): 1-5.
7.	陈先祥, 王江华, 蔡庆和, 等. 腹腔镜在再次胆道手术中的应用. 腹部外科, 2010, 23(1): 26-27.
8.	Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg, 2013, 206(4): 457-463.
9.	Kageoka M, Watanabe F, Maruyama Y, et al. Long-term prognosis of patients after endoscopic sphincterotomy for choledocholithiasis. Dig Endosc, 2009, 21(3): 170-175.
10.	中华医学会消化内镜分会 ERCP 学组. ERCP 诊治指南(2010 版)(一). 中华消化内镜杂志, 2010, 27(3): 113-118.
11.	Halawani HM, Tamim H, Khalifeh F, et al. Outcomes of laparoscopic vs open common bile duct exploration: analysis of the NSQIP database. J Am Coll Surg, 2017, 224(5): 833-840.
12.	陈安平, 鲁美丽, 田刚, 等. 开腹胆道术后腹腔镜再次胆道手术 24 例报告. 中国内镜杂志, 2002, 8(9): 45-46, 48.
13.	董家鸿. 胆道微创治疗必须高度重视 Oddi 括约肌的保护. 中华消化外科杂志, 2012, 11(5): 405-407.
14.	Dawe S R, Windsor J A, Broeders J A, et al. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg, 2014, 259(2): 236-248.
15.	严林, 侯静申, 修风民, 等. 腹腔镜联合胆道镜在肝外胆管结石再次手术中的应用价值. 中国普外基础与临床杂志, 2017, 24(8): 1011-1013.
16.	彭颖, 侯纯升, 徐智, 等. 腹腔镜手术治疗残余胆囊结石合并胆总管结石. 中国微创外科杂志, 2015, 15(2): 107-110.
17.	戴朝六, 赵阳. 肝内胆管结石的手术治疗及术式评价. 世界华人消化杂志, 2012, 20(34): 3332-3335.
18.	付庆江, 吴治宇, 孟晓东, 等. 开腹与腹腔镜胆道术后再次腹腔镜胆道手术的比较. 中华肝胆外科杂志, 2017, 23(1): 58-59.
19.	肖辉, 王建. 胆道镜联合钬激光治疗肝内外胆管难取性结石. 中国微创外科杂志, 2010, 10(1): 72-73.
20.	巴明臣, 陈训如, 陈积圣, 等. 有腹部手术史患者腹腔镜术闭合法建立气腹方法探讨. 中华普通外科杂志, 2000, 15(11): 671-672.
21.	Ercan M, Bostanci E B, Ulas M, et al. Effects of previous abdominal surgery incision type on complications and conversion rate in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 373-378.
22.	马向明, 付庆江, 田园, 等. 腹腔镜联合胆道镜治疗胆总管复发结石. 中华肝胆外科杂志, 2015, 21(1): 55-56.
23.	朱自满, 焦华波, 王大东, 等. 多次胆道术后再次胆道手术的临床分析. 临床肝胆病杂志, 2012, 28(4): 296-298.
24.	郭献廷, 许俊峰, 王育生. 腹腔镜在胆道再次手术中的应用. 中国普外基础与临床杂志, 2011, 18(8): 894-895.
25.	刘瑞文, 陈健, 于亚平. 上腹部手术史患者行腹腔镜胆总管切开取石术的应用体会. 腹腔镜外科杂志, 2013, 18(10): 764-766.

1. 张道建, 沈盛, 倪晓凌, 等. 肝胆管结石术后结石残留及复发诊治进展. 中国实用外科杂志, 2016, 36(3): 333-336.
2. Tian J, Li JW, Chen J, et al. Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases. Dig Liver Dis, 2013, 45(6): 493-498.
3. 龚连生, 张阳德, 刘恕, 等. 胆道术后腹腔镜再次手术. 中国内镜杂志, 2004, 10(10): 3-5.
4. 张楷, 詹峰, 张云, 等. 腹腔镜再次胆道手术治疗胆总管结石. 中华肝胆外科杂志, 2014, 20(4): 265-268.
5. Li L B, Cai X J, Mou Y P, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases. World J Gastroenterol, 2008, 14(19): 3081-3084.
6. 中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜治疗肝胆管结石病的专家共识(2013版). 中华消化外科杂志, 2013, 12(1): 1-5.
7. 陈先祥, 王江华, 蔡庆和, 等. 腹腔镜在再次胆道手术中的应用. 腹部外科, 2010, 23(1): 26-27.
8. Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg, 2013, 206(4): 457-463.
9. Kageoka M, Watanabe F, Maruyama Y, et al. Long-term prognosis of patients after endoscopic sphincterotomy for choledocholithiasis. Dig Endosc, 2009, 21(3): 170-175.
10. 中华医学会消化内镜分会 ERCP 学组. ERCP 诊治指南(2010 版)(一). 中华消化内镜杂志, 2010, 27(3): 113-118.
11. Halawani HM, Tamim H, Khalifeh F, et al. Outcomes of laparoscopic vs open common bile duct exploration: analysis of the NSQIP database. J Am Coll Surg, 2017, 224(5): 833-840.
12. 陈安平, 鲁美丽, 田刚, 等. 开腹胆道术后腹腔镜再次胆道手术 24 例报告. 中国内镜杂志, 2002, 8(9): 45-46, 48.
13. 董家鸿. 胆道微创治疗必须高度重视 Oddi 括约肌的保护. 中华消化外科杂志, 2012, 11(5): 405-407.
14. Dawe S R, Windsor J A, Broeders J A, et al. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg, 2014, 259(2): 236-248.
15. 严林, 侯静申, 修风民, 等. 腹腔镜联合胆道镜在肝外胆管结石再次手术中的应用价值. 中国普外基础与临床杂志, 2017, 24(8): 1011-1013.
16. 彭颖, 侯纯升, 徐智, 等. 腹腔镜手术治疗残余胆囊结石合并胆总管结石. 中国微创外科杂志, 2015, 15(2): 107-110.
17. 戴朝六, 赵阳. 肝内胆管结石的手术治疗及术式评价. 世界华人消化杂志, 2012, 20(34): 3332-3335.
18. 付庆江, 吴治宇, 孟晓东, 等. 开腹与腹腔镜胆道术后再次腹腔镜胆道手术的比较. 中华肝胆外科杂志, 2017, 23(1): 58-59.
19. 肖辉, 王建. 胆道镜联合钬激光治疗肝内外胆管难取性结石. 中国微创外科杂志, 2010, 10(1): 72-73.
20. 巴明臣, 陈训如, 陈积圣, 等. 有腹部手术史患者腹腔镜术闭合法建立气腹方法探讨. 中华普通外科杂志, 2000, 15(11): 671-672.
21. Ercan M, Bostanci E B, Ulas M, et al. Effects of previous abdominal surgery incision type on complications and conversion rate in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 373-378.
22. 马向明, 付庆江, 田园, 等. 腹腔镜联合胆道镜治疗胆总管复发结石. 中华肝胆外科杂志, 2015, 21(1): 55-56.
23. 朱自满, 焦华波, 王大东, 等. 多次胆道术后再次胆道手术的临床分析. 临床肝胆病杂志, 2012, 28(4): 296-298.
24. 郭献廷, 许俊峰, 王育生. 腹腔镜在胆道再次手术中的应用. 中国普外基础与临床杂志, 2011, 18(8): 894-895.
25. 刘瑞文, 陈健, 于亚平. 上腹部手术史患者行腹腔镜胆总管切开取石术的应用体会. 腹腔镜外科杂志, 2013, 18(10): 764-766.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical analysis of laparoscopic common bile duct reexploration in treatment of bile duct stones

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