Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.
Objective To analyze the clinical characteristics associated with hospital infections in patients with common bile duct stones treated by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), thereby providing a basis for selecting treatment strategies and formulating hospital infection prevention measures for such patients. Methods Patients with common bile duct stones at Jiangsu Provincial People’s Hospital between January 2020 and July 2023 were retrospectively selected and divided into ERCP and LCBDE groups according to their surgical methods. Basic patient data, length of hospital stay, hospitalization costs, perioperative infection-related indicators, and occurance of hospital infections were compared between groups. Results A total of 402 patients were enrolled, with 242 in the ERCP group and 160 in the LCBDE group. Significant differences were noted in smoking, alcohol consumption, history of lung diseases, history of heart diseases, history of cholecystectomy/biliary surgery, presence of cholecystitis, presence of cholecystolithiasis, number of stones, maximum stone diameter, common bile duct diameter, total hospital stay, and total expenses (P<0.05). Twenty-four hours before surgery, except for the neutrophil count, which was slightly higher in the ERCP group than that in the LCBDE group (P=0.043), the infection-related indicators did not differ significantly between the two groups (P>0.05). Twenty-four hours after surgery, the levels of serum white blood cell, neutrophil, and aspartate aminotransferase in the ERCP group were lower than those in the LCBDE group (P<0.05), and the levels of alkaline phosphatase and gamma-glutamyl transferase in the ERCP group were higher than those in the LCBDE group (P<0.05). A total of 179 bile samples were collected and tested, identifying 137 strains of pathogenic bacteria (78 in the ERCP group and 59 in the LCBDE group). In the ERCP group, 42 strains (53.85%) were Gram-negative bacteria, 34 strains (45.59%) were Gram-positive bacteria, and 2 strains (2.56%) were fungi; in the LCBDE group, 33 strains (55.93%) were Gram-negative bacteria and 26 strains (44.07%) were Gram-positive bacteria. No significant difference was observed in the composition of pathogenic bacteria between the two groups (χ2=1.174, P=0.695). Among the 402 patients, 38 cases of hospital infection occurred postoperatively, with an infection rate of 9.45%. The difference in the infection rate between the ERCP group and the LCBDE group were statistically significant (11.98% vs. 5.63%; χ2=4.550, P=0.033). The main sites of infection were bloodstream, lungs, and abdominal-pelvic cavity. Conclusions The predominant pathogens isolated after both ERCP and LCBDE are Gram-negative bacteria. Compared with LCBDE, ERCP has less impact on inflammatory markers, hospital stay, and costs, but has a higher incidence of hospital infections.
【Abstract】ObjectiveTo explore risk factors of bile leakage after primary ductal closure following choledochotomy. MethodsA retrospective clinical analysis was made in 148 cases of Ttube drainage and 154 cases of primary common bile duct suture following choledochotomy admitted to our hospital from January 1999 to June 2003. Results Postoperative bile leakage was seen in 11 patients of the group with Ttube drainage and in 16 patients of the group with primary suture respectively, there was no significant difference(Pgt;0.05).In the group with primary common bile duct suture,the occurrence of bile leakage was relative with hyperglycemia(Plt;0.05)，hypoproteinemia (Plt;0.01)，bile duct repeated sutures(Plt;0.01)and positive bacterial culture in bile(Plt;0.05). Bile leakage was not relative with elder age (Pgt;0.05).Conclusion It is the key factors,including chosing appropriate patients, intraoperative special examination, careful manipulation and effective medical treatment that can reduce the morbidity of bile leakage.
Object To evaluate the significance of double common bile duct （DCBD） in hepatobiliary surgery. Metheds The data of diagnosis and treatment of two patients with DCBD in our hospital between Jul. to Dec. 2010 were analyzed retrospective， and the related literatures were reviewed. Results The right hepatic bile duct of DCBD due to mistaking it for cystic duct in 1 case was accidental injuried during laparoscopic cholecystectomy. Another example，the DCBD was confirmed by intraoperative exploration and choledochoscopic examination， at the same time with chole-dochal cyst， anomalous pancreaticobiliary ductal junction （APBDJ）， primary hepatolithus， and choledocholith， and then operation was performed. Two cases were typeⅤb of DCBD. A total of 32 English literatures were reviewed. Since the beginning of 1932 English literature had reported 100 cases of DCBD. The type Ⅱand typeⅢwere the most common type of DCBD， and the typeⅤonly 10 cases. There were 27 cases of DCBD in twenty-five Chinese articles from 1994 to 2012. The typeⅤwas the most common type of DCBD. The accessory common bile duct （ACBD） opening in the duod-enum， gastric， and pancreatic duct were the most common. The common complications included stone， APBDJ， choled-ochal cyst， tumor etc. Conclusions DCBD is a very rare anatomic variation of extrahepatic bile duct， often accompanied by calculus of bile duct and common bile duct cyst， APBDJ， and other biliary anatomy abnormality， and potentially carci-nogenic potential. The existence of DCBD may increase the risk of iatrogenic bile duct injury and complexity of biliary operation. In view of this， this abnormality of extrahepatic duct should be paid with close attention during operation.
Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.
Objective To assess the benefits and harms of routine primary suture (LBEPS) versus T-tube drainage (LCHTD) following laparoscopic common bile duct stone exploration. Methods The randomized controlled trials (RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2010), PubMed (1978 to 2010), EMbase (1966 to 2010), CBMdisc (1978 to 2010), and CNKI (1979 to 2010); and the relevant published and unpublished data and their references were also searched by hand. The data were extracted and the quality was evaluated by two reviewers independently, and the RevMan 5.0 software was used for data analysis. Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included. The meta-analysis showed that compared with LCHTD, LBEPS was better in shortening operation time (WMD= –17.11, 95%CI –25.86 to –8.36), abdominal drainage time (WMD= –0.74, 95%CI –1.39 to –0.10) and post-operative hospitalization time (WMD= –3.30, 95%CI –3.67 to –2.92), in lowering hospital expenses (WMD= –2 998.75, 95%CI –4 396.24 to –1 601.26) and in reducing the complications due to T-tube such as tube detaching, bile leakage after tube drawing, and choleperitonitis (RR=0.56, 95%CI 0.29 to 1.09). Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication. Due to the low quality of the included studies which decreases the reliability of this conclusion, more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.
Objective To investigate the method of the treatment on cholecystolithiasis combined with calculus of common bile duct (CBD) by laparoscopy with combination of choledochoscope and duodenoscope and its significances. Methods Forty-two patients with cholecystolithiasis combined with calculus of CBD were treated by laparoscopy with combination of choledochoscope and duodenoscope from Jan. 2007 to Dec. 2008 in this hospital. Under general anesthesia, laparoscopic cholecystectomy was performed first, then the anterior wall of CBD was opened, calculus of CBD was treated by choledochoscope and duodenoscope intraoperatively. Then primary suture of the CBD was performed under laparoscope and nasobiliary drainage duct was placed. Results One case was converted to laparotomy, 41 cases succeeded and left hospital after being taken off the nasobiliary drainage duct in 5-7 d. No case died, no bile leakage, no bleeding or perforation of upper digestive tract, and no acute pancreatitis happened after operation. Conclusion Laparoscopy with combination of choledochoscope and duodenoscope treating cholecystolithiasis combined with calculus of CBD is a safe, effective and quickly recovering method with less sufferings and trauma.
ObjectiveTo compare difference of therapeutic effects between endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet (FREDDY) laser and endoscopic traditional mechanical lithotripsy in treatment of common bile duct stones (CBDs).MethodsThe clinical data of 207 patients with CBDs treated with ERCP and lithotripsy in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2009 to March 2019 were analyzed retrospectively, of which 71 cases treated by FREDDY (FREDDY group) and 136 cases treated by mechanical lithotripsy (mechanical group). The success rate of stone removal, operation time, postoperative hospitalization time, hospitalization cost, consumables cost, and complications were compared between the two groups.ResultsThere were no significant differences in the general condition and the preoperative clinical data between the two groups (P>0.05). There was no perioperative death in the two groups. There were no significant differences in terms of the postoperative routine laboratory biochemical indexes, consumables cost, hospitalization cost, and rates of the bleeding, postoperative pancreatitis, perforation and biliary tract infection between the two groups (P>0.05). Although the operation time of the FREDDY group was significantly longer than that of the mechanical group (P<0.05), the success rate of stone removal was significantly higher, the postoperative hospitalization time was shorter, the total complications rate and stone residual rate were significantly lower in the FREDDY group as compared with the mechanical group (P<0.05).ConclusionEndoscopic FREDDY laser lithotripsy has a better curative effect and less complications in treatment of large CBDs than mechanical lithotripsy, but operation time needs further to be improved.
Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.