Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct  

作　　者：Xiao-Xiao Huang Jia-Yi Wu Yan-Nan Bai Jun-Yi Wu Jia-Hui Lv Wei-Zhao Chen Li-Ming Huang Rong-Fa Huang Mao-Lin Yan 

机构地区：[1]Department of Hepatobiliary and Pancreatic Surgery,Shengli Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,Fujian Province,China

出　　处：《World Journal of Clinical Cases》2021年第8期1803-1813,共11页世界临床病例杂志

摘　　要：BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for patients with small CBD(CBD diameter≤8 mm),endoscopic sphincterotomy remains the preferred treatment at present,but it also has some drawbacks associated with a series of complications,such as pancreatitis,hemorrhage,cholangitis,and duodenal perforation.To date,few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODS A total of 257 patients without acute cholangitis who underwent LC+LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed.The clinical data were retrospectively collected and analyzed.According to whether the diameter of CBD was larger than 8 mm,257 patients were divided into large CBD group(n=146)and small CBD group(n=111).Propensity score matching(1:1)was performed to adjust for clinical differences.The demographics,intraoperative data,short-term outcomes,and long-term follow-up outcomes for the patients were recorded and compared.RESULTS In total,257 patients who underwent successful LC+LCBDE were enrolled in the study,146 had large CBD and 111 had small CBD.The median follow-up period was 39(14-86)mo.For small CBD patients,the median CBD diameter was 0.6 cm(0.2-2.0 cm),the mean operating time was 107.2±28.3 min,and the postoperative bile leak rate,rate of residual CBD stones(CBDS),CBDS recurrence rate,and CBD stenosis rate were 5.41%(6/111),3.60%(4/111),1.80%(2/111),and 0%(0/111),respectively;the mean postoperative hospital stay was 7.4±3.6 d.For large CBD patients,the median common bile duct diameter was 1.0 cm(0.3-3.0 cm),the mean operating time was 115.7±32.0 min,and the postoperative bile leak rate,rate of residual CBDS,CBDS recurrence rate,and CBD stenosis rate were 5.41%(9

关 键 词：Common bile duct stones Laparoscopic common bile duct exploration Endoscopic sphincterotomy Bile leak Choledochal stenosis RECURRENCE 

分 类 号：R657.4[医药卫生—外科学]