目的：总结运用腹腔镜胆总管探查术的治疗经验。方法：回顾性分析1992年3月～2006年12月运用腹腔镜胆总管探查术对1221例患者进行治疗的经验。结果：即时缝合671例中634例和T管引流550例中501例治疗获得成功。中转开腹9例，胆漏46例，术后残余结石内镜未取净11例，死亡5例。结论：只要选择合适的病例，腹腔镜胆总管探查术对于有较高内镜和腹腔镜技术者是可行、有效和安全的。
目的 探讨腹腔镜胆总管切开取石术的优势，总结手术操作经验及常见并发症的预防与处理。方法回顾性分析我院1999年6月至2010年4月期间收治的108 例胆管结石患者行腹腔镜胆总管探查取石术的手术方法、操作要点及并发症的处理。结果 腹腔镜手术成功 105例, 中转开腹3例; 手术时间（120±20） min,出血量（25±5） ml,住院时间（9±1） d; 术后发生胆道出血3例,漏胆7 例,残余结石6 例; 全组无死亡病例。结论 腹腔镜胆总管切开取石术具有创伤小、痛苦轻、恢复快、对腹腔脏器干扰小、住院时间短等优点，值得临床推广。
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
目的:总结应用腹腔镜联合胆道镜治疗胆总管结石的体会。方法:回顾分析2003年1月至2009年5月成都市第五人民医院联合应用腹腔镜胆道镜治疗胆总管结石的临床资料。结果:经胆囊颈管取石成功21例,切开胆总管取石27例,其中胆总管I期缝合17例,T管引流31例,3例术后发生胆总管残余结石,经T管窦道胆道镜取石治愈,5例中转开腹。结论:选择合适病例,腹腔镜联合胆道镜治疗胆总管结石患者创伤小,效果好,且安全可靠。
目的比较腹腔镜胆囊切除联合胆总管探查术（LC＋LCBDE）与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术（EST＋LC）治疗胆囊结石合并肝外胆管结石的临床疗效。 方法回顾性分析45例行LC＋LCBDE及60例行EST＋LC患者的临床资料，观察2组在单次结石清除率、中转手术率、手术并发症、住院时间等指标方面的效果。 结果2组患者的基线资料相近，无手术死亡病例；2组术后并发症发生情况的差异无统计学意义（P＞0.05）；LC＋LCBDE组单次治疗成功率高于EST＋LC组，而住院时间及中转手术率则短于或低于EST＋LC组（P＜0.05）。 结论LC＋LCBDE是治疗胆囊结石合并肝外胆管结石患者安全有效的方法。
ObjectiveTo explore how to select the suitable indications of ERCP for clinical diagnosis and treatment. MethodsThe data of patients treated by ERCP between January 2005 and December 2009 in our hospital were analyzed retrospectively. ResultsTotal 221 patients received ERCP, among whom 99 (45%) cases of common bile duct stones, 44 (20%) cases of malignant tumor, 9 (4%) cases of papilla narrow, 45 (20%) cases were negative, and 24 (11%) cases were failed. It had the trend that the number of the patients received ERCP reduced year by year. The postoperative complication rate was 11% (25 cases), including 15 cases of postoperative pancreatitis, 3 cases of bleeding, 5 cases of biliary duct infection, and 2 cases of basket stranded. ConclusionIn the modern medical condition, with the advancement of image and laparoscopy technology, we should select the diagnosis and treatment methods with the principles of no damage or less damage for patients, without unlimitedly broadening the clinical indications of ERCP.
目的比较腹腔镜下胆总管探查一期缝合与T管引流治疗肝外胆管结石的效果，总结腹腔镜下胆总管探查一期缝合的临床经验。 方法回顾性分析2010年1月至2012年12月期间于中国人民解放军总医院施行腹腔镜下胆总管探查取石的121例肝外胆管结石患者的临床资料，比较一期缝合组（n=63）与T管引流组（n=58）的手术时间、术中出血量、术后住院时间、胆瘘发生率、胆总管狭窄发生率及结石复发率。 结果2组患者均顺利完成腹腔镜手术。术后一期缝合组发生胆瘘3例，T管引流组发生1例。2组患者的术中出血量和胆瘘发生率比较差异均无统计学意义（P＞0.05），但T管引流组的手术时间和术后住院时间均较长（P=0.000）。术后所有患者获访4～36个月，平均12个月。随访期间均无复发、胆总管狭窄及死亡发生。 结论腹腔镜下胆总管探查一期缝合治疗肝外胆管结石安全而有效，并且避免了术后T管的护理，有望成为处理肝外胆管结石的主流术式。
Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct， and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy， the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation， intraoperativecholangiography， removal of stones with help of choledochoscope， and removal drainage tube after operation was from 90 to 200 min with an average of 100min， 3 to 10min with an average of 6min， 5 to 15 min with an average of 8 min，and 3-5d with an average of 3.5d ， respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage， abdominal pain， and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection， T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Objective To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.
ObjectiveTo compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.MethodsWe searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.ResultsA total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.ConclusionsBoth LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.