Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies

被引:37
作者
Fang, L. [1 ]
Wang, J. [2 ]
Dai, W. C. [3 ]
Liang, B. [1 ]
Chen, H. M. [1 ]
Fu, X. W. [1 ]
Zheng, B. B. [1 ]
Lei, J. [1 ]
Huang, C. W. [4 ]
Zou, S. B. [1 ]
机构
[1] Nanchang Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Mingde Rd 1, Nanchang 330000, Jiangxi, Peoples R China
[2] Nanchang Univ, Affiliated Hosp 3, Dept Hepatobiliary Surg, Nanchang, Jiangxi, Peoples R China
[3] Yili Friendship Hosp, Dept Gen Surg, Yili, Xinjiang, Peoples R China
[4] Peoples Hosp Jiangxi, Dept Hepatobiliary Surg, Nanchang, Jiangxi, Peoples R China
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2018年 / 32卷 / 12期
关键词
Laparoscopic transcystic common bile duct exploration; Cystic duct incision; Laser lithotripsy; Surgical strategy; FREDDY LASER; CYSTIC DUCT; MANAGEMENT; INCISION; STONES;
D O I
10.1007/s00464-018-6195-z
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundLTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones.MethodsTo describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed.ResultsCBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3-8mm, and 85 patients with cystic duct diameter 5mm. The mean time for CBD stone extraction was 25.3min, with the operative time ranged from 63 to 170min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter 5mm. Estimated blood loss during surgery was 10-120ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3-7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months.ConclusionsBased on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.
引用
收藏
页码:4742 / 4748
页数:7
相关论文
共 17 条
[1]   Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factor analysis [J].
Bove, A. ;
Bongarzoni, G. ;
Palone, G. ;
Di Renzo, R. M. ;
Calisesi, E. M. ;
Corradetti, L. ;
Di Nicola, M. ;
Corbellini, L. .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2009, 23 (07) :1470-1475
[2]   Transcystic Approach with Micro-incision of the Cystic Duct and Its Confluence Part in Laparoscopic Common Bile Duct Exploration [J].
Chen, Xue-Min ;
Zhang, Yue ;
Cai, Hui-Hua ;
Sun, Dong-Lin ;
Liu, Sheng-Yong ;
Duan, Yun-Fei ;
Yang, Chun ;
Jiang, Yong ;
Wu, Hao-Rong .
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2013, 23 (12) :977-981
[3]   Clinical role of frequency-doubled double-pulsed yttrium aluminum garnet laser technology for removing difficult bile duct stones (with videos) [J].
Cho, Young Deok ;
Cheon, Young Koog ;
Moon, Jong Ho ;
Jeong, Soung Won ;
Jang, Jae Young ;
Lee, Joon Seong ;
Shim, Chan Sup .
GASTROINTESTINAL ENDOSCOPY, 2009, 70 (04) :684-689
[4]   In vitro analysis of stone fragmentation ability of the FREDDY laser [J].
Delvecchio, FC ;
Auge, BK ;
Brizuela, RM ;
Weizer, AZ ;
Zhong, P ;
Preminger, GM .
JOURNAL OF ENDOUROLOGY, 2003, 17 (03) :177-179
[5]   Role of laparoscopic common bile duct exploration in the management of choledocholithiasis [J].
Gupta, Nikhil .
WORLD JOURNAL OF GASTROINTESTINAL SURGERY, 2016, 8 (05) :376-381
[6]   Management hepatolithiasis with operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy [J].
Jiang, Zhi-Jun ;
Chen, Ying ;
Wang, Wei-Lin ;
Shen, Yan ;
Zhang, Min ;
Xie, Hai-Yang ;
Zhou, Lin ;
Zheng, Shu-Sen .
HEPATOBILIARY & PANCREATIC DISEASES INTERNATIONAL, 2013, 12 (02) :160-164
[7]   Laparoscopic CBD exploration using a V-shaped choledochotomy [J].
Kim, Eun Young ;
Lee, Soo Ho ;
Lee, Jun Suh ;
Hong, Tae Ho .
BMC SURGERY, 2015, 15
[8]   Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser [J].
Kim, Tae Hyeon ;
Oh, Hyo Jeong ;
Choi, Chang-Soo ;
Yeom, Dong Han ;
Choi, Suck Chei .
WORLD JOURNAL OF GASTROENTEROLOGY, 2008, 14 (18) :2863-2866
[9]   Epidemiology and natural history of common bile duct stones and prediction of disease [J].
Ko, CW ;
Lee, SP .
GASTROINTESTINAL ENDOSCOPY, 2002, 56 (06) :S165-S169
[10]   Laparoscopic Transcystic Common Bile Duct Exploration: T-Shaped Incision of Cystic Duct with FREDDY Laser Lithotripsy [J].
Lei, Jun ;
Wang, Jun ;
Li, Qiang ;
Wu, Peng ;
Yuan, Rongfa ;
Zhu, Hengqing ;
Zou, Shubing ;
Shao, Jianghua ;
Fang, Lu .
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2016, 26 (08) :646-651