Application of laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiog-raphy for patients with cholecystocholedocholithiasis
Objective To explore the clinical application of laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography in treatment of patients with cholecystocholedocholithiasis.Methods Clinical data of 113 patients with cholecystocholedocholithiasis admitted in Huzhou Central Hospital from October 2020 to March 2023 were enrolled,including 32 cases treated by laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography(LTCCBDE group),39 cases treated by laparoscopic trans-duct common bile duct exploration plus T-tube drain(LTDCBDE group),and 42 cases treated by laparoscopic cholecystectomy+endoscopic retrograde cholangiopancreatography+endoscopic sphincterotomy(LC+ERCP+EST group).The preoperative and postoperative ALT,TBil,DBil,ilBil,WBC,CRP,postoperative amylase(AMY),operative time and intraoperative bleeding,postoperative biliary fistula rate,postoperative hospital stay,hospitalization cost and the perioperative gastrointestinal quality of life index(GIQLI)at 6th week were compared among three groups.Results Among 36 cases scheduled to receive LTCCBDE,4 cases failed and transferred to LTDCBDE.Thirty-nine cases in LTDCBDE group and 42 cases in LC+ERCP+EST group were treated successfully.There were significant differences in preoperative WBC,ALT,TBil,IBil and postoperative CRP and ALT between LTCCBDE and LTDCBDE groups(all P＜0.05).There were significantly different in preoperative WBC and postoperative ALT between LTCCBDE and LC+ERCP+EST groups(both P＜0.05).The operative time in LTCCBDE group was significantly lower than those in LTDCBDE and LC+ERCP+EST groups(both P＜0.05).The intraoperative bleeding and postoperative hospital stay in LTCCBDE group were significantly lower than those in LTDCBDE group(both P＜0.05)and there were no significant differences between LTCCBDE and LC+ERCP+EST groups(both P＞0.05).There were statistically significant in hospitalization costs and postoperative GIQLI scores at 6th week in LTCCBDE group compared to LTDCBDE and LC+ERCP+EST groups respectively(all P＜0.001).Conclusion Laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography is effective in treatment of patients with cholecystocholedocholithiasis.It can accelerate postoperative rehabilitation and improve the quality of life in consistent with the concept of enhanced recovery after surgery(ERAS),therefore,it merits clinical application.
CholedocholithiasisCholecystolithiasisCommon bile duct explorationCystic ductLaparoscopy
万方数据
维普
