Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAO Tao , SHI Gang , PENG Xiangyu , ZHAO Guogang

Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

Keywords：

Laparoscope; Choledochoscopy; Common bile duct stone; Common bile duct primary suture; Indication

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD.
Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed.
Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy.
Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.

Citation： TAO Tao,SHI Gang,PENG Xiangyu,ZHAO Guogang. Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(8): 649-653. doi: Copy

1.	张雷达, 别平, 陈平. 腹腔镜胆道探查术后胆管一期缝合与 T管引流的疗效比较 [Ｊ]. 中华外科杂志, 2004； 42(9): 520-523.
2.	许卓明, 甄作均, 苏树英, 等. 腹腔镜胆总管切开术: T管引流还是一期缝合 [Ｊ]. 中国内镜杂志, 2007； 13(4): 401-404.
3.	王京立, 杨敖霖, 陆春雷. 腹腔镜胆总管探查、一期缝合的应用研究 [Ｊ]. 中国微创外科杂志, 2006； 6(1): 19-20.
4.	龚仁华, 孙登群, 范育林, 等. 腹腔镜下胆总管探查一期缝合的临床应用 [Ｊ]. 肝胆外科杂志, 2007； 15(4): 256-257.
5.	刘蔚东, 张阳德, 龚连生, 等. 腹腔镜下胆总管切开取石一期缝合术 [Ｊ]. 中国现代医学杂志, 2004； 14(13): 10-15.
6.	索运生, 徐琳, 陈安平, 等. 腹腔镜胆总管探查一期缝合669例报告 [J]. 中国微创外科杂志, 2008; 8(10): 942-944.
7.	孙利国, 刘小敏. 胆总管切开取石Ⅰ期缝合64例报道 [Ｊ]. 中国普外基础与临床杂志, 2007； 14(1): 109.
8.	陈佐会, 罗平. 内镜、腹腔镜联合治疗胆囊结石合并胆总管结石（附51例报告） [Ｊ]. 中国普外基础与临床杂志, 2005； 12(6): 569-570.
9.	胡三元, 刘军, 姜希宏, 等. 腹腔镜胆总管切开取石术93例报告 [Ｊ]. 中华肝胆外科杂志, 1999； 5（2）: 131-132.
10.	洪德飞, 高敏, 牟一平, 等. 腹腔镜胆囊切除术中联合括约肌切开取石的研究 [Ｊ]. 中华外科杂志, 2000； 38（9）: 677-679.
11.	牛军, 牛卫博, 张朝阳, 等. 腹腔镜胆总管切开取石 T管引流术: 15年经验回顾与展望 [Ｊ]. 中国现代普通外科进展, 2007； 10(2): 108-111.
12.	Tranter SE, Thompson MH. Comparison of endoscopic sph-incterotomy and laparoscopic exploration of the common bile duct [Ｊ]. Br J Surg, 2002; 89(12): 1495-1504.
13.	Rojas-Ortega S, Arizpe-Bravo D, Marín López ER, et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis [Ｊ]. J Gastrointest Surg, 2003; 7(4): 492-496.
14.	Paganini AM, Feliciotti F, Guerrieri M, et al. Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients [Ｊ]. Surg Endosc, 2002; 16(9): 1302-1308.
15.	Griniatsos J, Karvounis E, Arbuckle J, et al. Cost-effective method for laparoscopic choledochotomy [Ｊ]. ANZ J Surg, 2005; 75(1-2): 35-38.
16.	Tanaka M, Takahata S, Konomi H, et al. Long-term consequence of endoscopic sphincterotomy for bile duct stones [Ｊ]. Gastrointest Endosc, 1998; 48(5): 465-469.
17.	Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term results of laparoscopic common bile duct exploration [Ｊ]. Surg Endosc, 2003; 17(1): 19-22.
18.	何庆良, 石铮, 陈有挺, 等. 胆总管切开取石探查后一期缝合的研究 [Ｊ]. 中国现代医学杂志, 2006; 16(22): 3460-3461.
19.	吴硕东. 胆管结石的内镜治疗近况 [Ｊ]. 肝胆外科杂志, 2002； 10(1): 8-9.
20.	Sultan S, Baillie J. Recurrent bile duct stones after endoscopic sphincterotomy [Ｊ]. Gut, 2004; 53(12): 1725-1727.
21.	Prat F, Malak NA, Pelletier G, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis [Ｊ]. Gastroenterology, 1996; 110(3): 894-899.
22.	李根丛, 李宏, 万世泽, 等. 腹腔镜胆总管切开探查取石、T管引流治疗胆总管结石 [Ｊ]. 中国普外基础与临床杂志, 2001； 8(3): 179-181.
23.	Martin IJ, Bailey IS, Rhodes M, et al. Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures [Ｊ]. Ann Surg, 1998; 228(1): 29-34.
24.	林西青, 王卫星, 陈辰, 等. 腹腔镜不同方式治疗胆囊结石合并胆总管结石的临床分析 [Ｊ]. 临床外科杂志, 2007； 15(5): 326-327.
25.	Boughey JC, Nottingham JM. Choledocholithiasis in the laparoscopic era [Ｊ]. Curr Surg, 2003； 60(2): 103-107.
26.	陶涛, 彭祥玉, 雷俊阳, 等. 纤维胆道镜和腹腔镜联合治疗胆总管结石(附82例) [Ｊ]. 中国内镜杂志, 2002； 8(12): 4-6.
27.	彭祥玉, 赵国刚, 陶涛, 等. 经腹腔镜胆道镜取石胆总管一期缝合91例报告 [Ｊ]. 中华消化内镜杂志, 2003； 20(1): 42.
28.	Tokumura H, Umezawa A, Cao H, et al. Laparoscopic man-agement of common bile duct stones: transcystic approach and choledochotomy [Ｊ]. J Hepatobiliary Pancreat Surg, 2002; 9(2): 206-212.
29.	Decker G, Borie F, Millat B, et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct [Ｊ]. Surg Endosc, 2003; 17(1): 12-18.
30.	张寰. 腹腔镜下胆总管切开胆道镜探查取石术现状与评价 [Ｊ]. 中国实用外科杂志, 2009； 29(1): 47-49.
31.	Hunter JG, Soper NJ. Laparoscopic management of bile duct stones [Ｊ]. Surg Clin North Am, 1992; 72(5): 1077-1097.
32.	Thompson MH, Tranter SE. All-comers policy for laparoscopic exploration of the common bile duct [Ｊ]. Br J Surg, 2002; 89(12): 1608-1612.
33.	Shimizu S, Yokohata K, Mizumoto K, et al. Laparoscopic choledochotomy for bile duct stones [Ｊ]. J Hepatobiliary Pancreat Surg, 2002; 9(2): 201-205.
34.	Wills VL, Gibson K, Karihaloot C, et al. Complications of biliary T-tubes after choledochotomy [Ｊ]. ANZ J Surg, 2002; 72(3): 177-180.

1. 张雷达, 别平, 陈平. 腹腔镜胆道探查术后胆管一期缝合与 T管引流的疗效比较 [Ｊ]. 中华外科杂志, 2004； 42(9): 520-523.
2. 许卓明, 甄作均, 苏树英, 等. 腹腔镜胆总管切开术: T管引流还是一期缝合 [Ｊ]. 中国内镜杂志, 2007； 13(4): 401-404.
3. 王京立, 杨敖霖, 陆春雷. 腹腔镜胆总管探查、一期缝合的应用研究 [Ｊ]. 中国微创外科杂志, 2006； 6(1): 19-20.
4. 龚仁华, 孙登群, 范育林, 等. 腹腔镜下胆总管探查一期缝合的临床应用 [Ｊ]. 肝胆外科杂志, 2007； 15(4): 256-257.
5. 刘蔚东, 张阳德, 龚连生, 等. 腹腔镜下胆总管切开取石一期缝合术 [Ｊ]. 中国现代医学杂志, 2004； 14(13): 10-15.
6. 索运生, 徐琳, 陈安平, 等. 腹腔镜胆总管探查一期缝合669例报告 [J]. 中国微创外科杂志, 2008; 8(10): 942-944.
7. 孙利国, 刘小敏. 胆总管切开取石Ⅰ期缝合64例报道 [Ｊ]. 中国普外基础与临床杂志, 2007； 14(1): 109.
8. 陈佐会, 罗平. 内镜、腹腔镜联合治疗胆囊结石合并胆总管结石（附51例报告） [Ｊ]. 中国普外基础与临床杂志, 2005； 12(6): 569-570.
9. 胡三元, 刘军, 姜希宏, 等. 腹腔镜胆总管切开取石术93例报告 [Ｊ]. 中华肝胆外科杂志, 1999； 5（2）: 131-132.
10. 洪德飞, 高敏, 牟一平, 等. 腹腔镜胆囊切除术中联合括约肌切开取石的研究 [Ｊ]. 中华外科杂志, 2000； 38（9）: 677-679.
11. 牛军, 牛卫博, 张朝阳, 等. 腹腔镜胆总管切开取石 T管引流术: 15年经验回顾与展望 [Ｊ]. 中国现代普通外科进展, 2007； 10(2): 108-111.
12. Tranter SE, Thompson MH. Comparison of endoscopic sph-incterotomy and laparoscopic exploration of the common bile duct [Ｊ]. Br J Surg, 2002; 89(12): 1495-1504.
13. Rojas-Ortega S, Arizpe-Bravo D, Marín López ER, et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis [Ｊ]. J Gastrointest Surg, 2003; 7(4): 492-496.
14. Paganini AM, Feliciotti F, Guerrieri M, et al. Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients [Ｊ]. Surg Endosc, 2002; 16(9): 1302-1308.
15. Griniatsos J, Karvounis E, Arbuckle J, et al. Cost-effective method for laparoscopic choledochotomy [Ｊ]. ANZ J Surg, 2005; 75(1-2): 35-38.
16. Tanaka M, Takahata S, Konomi H, et al. Long-term consequence of endoscopic sphincterotomy for bile duct stones [Ｊ]. Gastrointest Endosc, 1998; 48(5): 465-469.
17. Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term results of laparoscopic common bile duct exploration [Ｊ]. Surg Endosc, 2003; 17(1): 19-22.
18. 何庆良, 石铮, 陈有挺, 等. 胆总管切开取石探查后一期缝合的研究 [Ｊ]. 中国现代医学杂志, 2006; 16(22): 3460-3461.
19. 吴硕东. 胆管结石的内镜治疗近况 [Ｊ]. 肝胆外科杂志, 2002； 10(1): 8-9.
20. Sultan S, Baillie J. Recurrent bile duct stones after endoscopic sphincterotomy [Ｊ]. Gut, 2004; 53(12): 1725-1727.
21. Prat F, Malak NA, Pelletier G, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis [Ｊ]. Gastroenterology, 1996; 110(3): 894-899.
22. 李根丛, 李宏, 万世泽, 等. 腹腔镜胆总管切开探查取石、T管引流治疗胆总管结石 [Ｊ]. 中国普外基础与临床杂志, 2001； 8(3): 179-181.
23. Martin IJ, Bailey IS, Rhodes M, et al. Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures [Ｊ]. Ann Surg, 1998; 228(1): 29-34.
24. 林西青, 王卫星, 陈辰, 等. 腹腔镜不同方式治疗胆囊结石合并胆总管结石的临床分析 [Ｊ]. 临床外科杂志, 2007； 15(5): 326-327.
25. Boughey JC, Nottingham JM. Choledocholithiasis in the laparoscopic era [Ｊ]. Curr Surg, 2003； 60(2): 103-107.
26. 陶涛, 彭祥玉, 雷俊阳, 等. 纤维胆道镜和腹腔镜联合治疗胆总管结石(附82例) [Ｊ]. 中国内镜杂志, 2002； 8(12): 4-6.
27. 彭祥玉, 赵国刚, 陶涛, 等. 经腹腔镜胆道镜取石胆总管一期缝合91例报告 [Ｊ]. 中华消化内镜杂志, 2003； 20(1): 42.
28. Tokumura H, Umezawa A, Cao H, et al. Laparoscopic man-agement of common bile duct stones: transcystic approach and choledochotomy [Ｊ]. J Hepatobiliary Pancreat Surg, 2002; 9(2): 206-212.
29. Decker G, Borie F, Millat B, et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct [Ｊ]. Surg Endosc, 2003; 17(1): 12-18.
30. 张寰. 腹腔镜下胆总管切开胆道镜探查取石术现状与评价 [Ｊ]. 中国实用外科杂志, 2009； 29(1): 47-49.
31. Hunter JG, Soper NJ. Laparoscopic management of bile duct stones [Ｊ]. Surg Clin North Am, 1992; 72(5): 1077-1097.
32. Thompson MH, Tranter SE. All-comers policy for laparoscopic exploration of the common bile duct [Ｊ]. Br J Surg, 2002; 89(12): 1608-1612.
33. Shimizu S, Yokohata K, Mizumoto K, et al. Laparoscopic choledochotomy for bile duct stones [Ｊ]. J Hepatobiliary Pancreat Surg, 2002; 9(2): 201-205.
34. Wills VL, Gibson K, Karihaloot C, et al. Complications of biliary T-tubes after choledochotomy [Ｊ]. ANZ J Surg, 2002; 72(3): 177-180.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases)

Abstract Full text Figures/Tables Video References Cited by

Format

Content