| Background:Laparoscopic common bile duct exploration(LCBDE)is one of the main methods for the treatment of large-diameter common bile duct stones.For patients with choledocholithiasis whose diameter is less than 8mm,the bile duct diameter is relatively small,the bile duct wall is thin,and suture is difficult,which leads to bile leakage or biliary stricture after surgery.Whether laparoscopic cholecystectomy(LC)combined with LCBDE is safe and feasible treatment of small-diameter cholecystectomy has not been reported in large cases.ObjectiveTo investigate the feasibility and safety of LC combined with LCBDE in treatment of cholecystolithiasis and small-diameter choledocholithiasisMethods:This study retrospectively analyzed the data of 217 patients of cholecystolithiasis complicated with choledocholithiasis undergoing LC combined with LCBDE primary suture in the department of hepatobiliary surgery of Fujian provincial hospital from January 2014 to December 2018.According to the diameter of the most dilation,113 cases were divided into the small-diameter group(0.6cm≤ internal diameter of common bile duct ≤0.8cm)and 104 cases into the larger-diameter group(0.8cm < internal diameter of common bile duct ≤1.5cm).The operation time,intraoperative blood loss,conversion rate to laparotomy,stone clearance rate,postoperative situation and long-term postoperative complications such as bile leakage,bile duct stenosis and stone recurrence of the two groups were compared and analyzed.Results:Except for the differences in stone size,there was no significant difference in baseline comparison between the two groups.The operating time of the small-diameter group was(108.6±29.9)min,and that of the large diameter group was(117.0±35.6)min,there was no significant difference in operation time between the two groups(P> 0.05).Intraoperative blood loss 20(10-200)ml in the small-diameter group and 30(10±200)ml in the large-diameter group showed no significant difference between the two groups(P > 0.05).3 patients had residual stones in the small-diameter group and 2had residual stone in the large-diameter group.The stone clearance rates of the two groups were 97.3% and 98.1%,respectively,with no significant difference(P >0.05).In the small diameter group,no patient switched to laparotomy,while in the large diameter group,1 patient switched to laparotomy.The rate of switching to laparotomy in the two groups was 0,1.0%,respectively,with no statistically significant difference(P > 0.05).8patients had bile leakage in the small-diameter group and were cured by non-surgical treatment.5patients also had bile leakage in the large-diameter group,1 patient was cured after reoperation,and the rest were cured by non-surgical treatment.The difference between the two groups was not statistically significant(P > 0.05).In the small-diameter group,no patient had postoperative hemorrhage,2 patients had incision infection,4 patients had abdominal infection,2 patients had pulmonary infection.respectively,In the large-diameter group,no patient had postoperative hemorrhage,4 patients had incision infection,4 patients had abdominal infection,3 patients had pulmonary infection,the difference between two groups was not statistically significant(P >0.05).Patients in the two groups were followed up for 12-72 months,with an average follow-up time of 35 months.No postoperative biliary stricture was found in all patients.4 patients had stone recurrence after operation in the small-diameter groups,and 5 patients had stone recurrence after operation in the large-diameter groups,The difference between the two groups was not statistically significant(P >0.05).Conclusion:LC combined with LCBDE primary suture in the treatment of small-diameter choledocholithiasis does not increase the rate of conversion to laparotomy,intraoperative and postoperative complications.Selecting the appropriate patients to perform LCBDE primary suture is safe and feasible for small-diameter choledocholithiasis. |
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