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

Video：

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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.	張道建, 沈盛, 倪曉凌, 等. 肝膽管結石術后結石殘留及復發診治進展. 中國實用外科雜志, 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.	龔連生, 張陽德, 劉恕, 等. 膽道術后腹腔鏡再次手術. 中國內鏡雜志, 2004, 10(10): 3-5.
4.	張楷, 詹峰, 張云, 等. 腹腔鏡再次膽道手術治療膽總管結石. 中華肝膽外科雜志, 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.	中國醫師協會外科醫師分會微創外科醫師專業委員會. 腹腔鏡治療肝膽管結石病的專家共識(2013版). 中華消化外科雜志, 2013, 12(1): 1-5.
7.	陳先祥, 王江華, 蔡慶和, 等. 腹腔鏡在再次膽道手術中的應用. 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.	中華醫學會消化內鏡分會 ERCP 學組. ERCP 診治指南(2010 版)(一). 中華消化內鏡雜志, 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.	陳安平, 魯美麗, 田剛, 等. 開腹膽道術后腹腔鏡再次膽道手術 24 例報告. 中國內鏡雜志, 2002, 8(9): 45-46, 48.
13.	董家鴻. 膽道微創治療必須高度重視 Oddi 括約肌的保護. 中華消化外科雜志, 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.	嚴林, 侯靜申, 修風民, 等. 腹腔鏡聯合膽道鏡在肝外膽管結石再次手術中的應用價值. 中國普外基礎與臨床雜志, 2017, 24(8): 1011-1013.
16.	彭穎, 侯純升, 徐智, 等. 腹腔鏡手術治療殘余膽囊結石合并膽總管結石. 中國微創外科雜志, 2015, 15(2): 107-110.
17.	戴朝六, 趙陽. 肝內膽管結石的手術治療及術式評價. 世界華人消化雜志, 2012, 20(34): 3332-3335.
18.	付慶江, 吳治宇, 孟曉東, 等. 開腹與腹腔鏡膽道術后再次腹腔鏡膽道手術的比較. 中華肝膽外科雜志, 2017, 23(1): 58-59.
19.	肖輝, 王建. 膽道鏡聯合鈥激光治療肝內外膽管難取性結石. 中國微創外科雜志, 2010, 10(1): 72-73.
20.	巴明臣, 陳訓如, 陳積圣, 等. 有腹部手術史患者腹腔鏡術閉合法建立氣腹方法探討. 中華普通外科雜志, 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.	馬向明, 付慶江, 田園, 等. 腹腔鏡聯合膽道鏡治療膽總管復發結石. 中華肝膽外科雜志, 2015, 21(1): 55-56.
23.	朱自滿, 焦華波, 王大東, 等. 多次膽道術后再次膽道手術的臨床分析. 臨床肝膽病雜志, 2012, 28(4): 296-298.
24.	郭獻廷, 許俊峰, 王育生. 腹腔鏡在膽道再次手術中的應用. 中國普外基礎與臨床雜志, 2011, 18(8): 894-895.
25.	劉瑞文, 陳健, 于亞平. 上腹部手術史患者行腹腔鏡膽總管切開取石術的應用體會. 腹腔鏡外科雜志, 2013, 18(10): 764-766.

1. 張道建, 沈盛, 倪曉凌, 等. 肝膽管結石術后結石殘留及復發診治進展. 中國實用外科雜志, 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. 龔連生, 張陽德, 劉恕, 等. 膽道術后腹腔鏡再次手術. 中國內鏡雜志, 2004, 10(10): 3-5.
4. 張楷, 詹峰, 張云, 等. 腹腔鏡再次膽道手術治療膽總管結石. 中華肝膽外科雜志, 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. 中國醫師協會外科醫師分會微創外科醫師專業委員會. 腹腔鏡治療肝膽管結石病的專家共識(2013版). 中華消化外科雜志, 2013, 12(1): 1-5.
7. 陳先祥, 王江華, 蔡慶和, 等. 腹腔鏡在再次膽道手術中的應用. 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. 中華醫學會消化內鏡分會 ERCP 學組. ERCP 診治指南(2010 版)(一). 中華消化內鏡雜志, 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. 陳安平, 魯美麗, 田剛, 等. 開腹膽道術后腹腔鏡再次膽道手術 24 例報告. 中國內鏡雜志, 2002, 8(9): 45-46, 48.
13. 董家鴻. 膽道微創治療必須高度重視 Oddi 括約肌的保護. 中華消化外科雜志, 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. 嚴林, 侯靜申, 修風民, 等. 腹腔鏡聯合膽道鏡在肝外膽管結石再次手術中的應用價值. 中國普外基礎與臨床雜志, 2017, 24(8): 1011-1013.
16. 彭穎, 侯純升, 徐智, 等. 腹腔鏡手術治療殘余膽囊結石合并膽總管結石. 中國微創外科雜志, 2015, 15(2): 107-110.
17. 戴朝六, 趙陽. 肝內膽管結石的手術治療及術式評價. 世界華人消化雜志, 2012, 20(34): 3332-3335.
18. 付慶江, 吳治宇, 孟曉東, 等. 開腹與腹腔鏡膽道術后再次腹腔鏡膽道手術的比較. 中華肝膽外科雜志, 2017, 23(1): 58-59.
19. 肖輝, 王建. 膽道鏡聯合鈥激光治療肝內外膽管難取性結石. 中國微創外科雜志, 2010, 10(1): 72-73.
20. 巴明臣, 陳訓如, 陳積圣, 等. 有腹部手術史患者腹腔鏡術閉合法建立氣腹方法探討. 中華普通外科雜志, 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. 馬向明, 付慶江, 田園, 等. 腹腔鏡聯合膽道鏡治療膽總管復發結石. 中華肝膽外科雜志, 2015, 21(1): 55-56.
23. 朱自滿, 焦華波, 王大東, 等. 多次膽道術后再次膽道手術的臨床分析. 臨床肝膽病雜志, 2012, 28(4): 296-298.
24. 郭獻廷, 許俊峰, 王育生. 腹腔鏡在膽道再次手術中的應用. 中國普外基礎與臨床雜志, 2011, 18(8): 894-895.
25. 劉瑞文, 陳健, 于亞平. 上腹部手術史患者行腹腔鏡膽總管切開取石術的應用體會. 腹腔鏡外科雜志, 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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