The Comparative Study Between Two Different Ways Of Bile Duct Stones Combined With Laparoscopic For The Treatment Of Extrahepatic Bile Duct Stones

Background: Biliary system, gallbladder stones are the most commondiseases. About 10% ~ 18% of the common bile duct stones in the gallbladderstones were merged, for the treatment of these patients, the traditional approachis laparotomy cholecystectomy at the same time line choledocholithotomy,T-tube drainage. Today, laparoscopy has become more sophisticated, andduodenal Choledochofiberscope extensive use of mirrors, "Three-mirror," anorganic combination of treatment of common bile duct stones has become a veryeffective minimally invasive treatment methods, such as laparoscopic commonbile duct incision , laparoscopic lithotomy via the cystic duct, endoscopicsphincterotomy. Are used clinically, and have achieved good effect.Objective: To investigate the efficacy of two strategies in the treatment ofcholecystolithiasis complicatedwith secondary common bile duct stones:laparoscopic cholecystectomy with transcytic common bile duct exploration(LC+ LBDE), or laparoscopic cholecystectomy after endoscopic sphincterotomy (EST + LC). Explore the treatment of cholecystolithiasis and common bile ductstones in the best way.Methods: On the Sino-Japanese Friendship Hospital, Jilin University,Department of Surgery and the other top three teaching hospitals from 2005 to2009 combined laparoscopy and duodenoscopy choledochofiberscopy 116 casesof gallstone with bile duct stones were retrospectively analyzed . The group of116 cases of cholecystolithiasis and among the extrahepatic bile duct stones, 54male and female 62 cases, male to female ratio = 0.87:1. Aged 23 to 86 years old,with a median age of 46 years, history of a minimum of 3 days and the longest26 years, an average of 42 months. A history of yellowish discoloration of skinand sclera (94 cases 81.0%), upper abdominal pain history (116 cases 100%),weight loss (42 cases 36.2%), gallstone pancreatitis (35 cases 30.1%), low backpain (68 cases 58.6%). Signs are stained yellow skin and sclera (94 cases 81.0%),abdominal tenderness (56 cases 48.2%). In 116 examples the line of LCBDE 60examples, LC unites the EST 56 examples. The result with(?x±s) indicated thatcarries on the group material T-test?The result with ( using a SPSS 13.0 statisticspackage of software.Results: 1. MRCP diagnosis of biliary stones in line with the rate of up to100%, ultrasound and CT scan contrast (P>0.05) difference was not statisticallysignificant, while the MRCP compared with other inspection groups (P<0.05)are statistically significant.2. The patients were successful line of LC combinedLDBE 60 patients, surgical success rate of 96.7%, converted to laparotomy in 2 cases, laparotomy rate of 3.3%; mean operative time was 125 minutes, theaverage hospital stay 8 days; line LC United EST 56 cases 52 cases of success, asuccess rate of 92.8%; mean operative time was 160 minutes, the averagehospital stay 13 days. 3.LC recent joint LBDE complications after bile leakagein 2 cases of residual stones in 2 cases, postoperative complications occur inapproximately 6.7%; long-term follow-up 42, up 70%, biliary tract infectionoccurs 1 cases, 1 case of gallstone pancreatitis, long-term complication rate was4.7%. LC United EST postoperative complications in 3 cases of pancreatitis,bleeding in 1 case, residual stones in 2 cases, 2 cases of biliary fistula,postoperative complication rate was 14.3%; long-term follow-up 35, follow-uprate 62.5% stone recurrence occurred in 3 cases, 2 cases of biliary tract infection,1 case of gallstone pancreatitis, long-term complication rate was 17.1%.Conclusion: LCBDE and EST + LC are two minimally invasive surgeryfor the treatment of cholecystolithiasis and common bile duct stones, both havetheir advantages. Two procedures in the hospital stay was no significantdifference, LC + LBDE operative time was less than the control group, thepostoperative complication rate was slightly lower than EST + LC, long-termeffect is also superior to EST + LC .