A Clinical Study Of LCBDE+LC And EST+LC In The Treatment Of Extrahepatic Bile Duct Stones

[Objectives] Through a comparative analysis of the therapeutic effects and strategies of a minimally invasive treatment by laparoscopic common bile duct exploration(LCBDE) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC), we aimed to explore how to choose a better minimally invasive treatment method of extrahepatic bile duct stones.[Methods3The data of86extrahepatic bile duct stones patients,who were hospitalized in the Department of Hepatobiliary Surgery at the secend affiliated hospital of Kunming Medical University from December,2012to December,2013, was collected for a clinical retrospective analysis. All patients were divided into two groups, according to their different methods of minimally invasive treatment^1)44cases in the LCBDE+LC group accepted the method of laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy.(2)42cases in the EST+LC group accepted the method of endoscopic sphincterotomy combined with laparoscopic cholecystectomy. And indexes such as the success rate of the operation, the incidence rate of postoperative complications, changes of hepatic function around the operation, the short-term recurrence rate of stones, the amount of bleeding during the operation, the time from the recovery of gastrointestinal function to starting eating, the hospitalization expenses, and the hospitalization days between the two groups were compared.[Results] The LCBDE+LC group:The success rate of the operation was95.6%(44/46cases), and the two LCBDE+LC-failed patients turned to accept the laparotomy operation, with one case for a severe intraperitoneal adhesion induced by an upper abdominal operation, and the other one for an unclear boundary between the gallbladder triangle and the ductuli hepaticus communis caused by an acute cholecystitis. The incidence rate of postoperative complications was4.54%(2/44cases), with a case developing an acute cholangitis infection, and the other one case developing a bile leakage. The EST+LC group:The success rate of the operation was95.5%(42/44cases), and the two EST+LC-failed patients turned to the LCBDE surgery, with one case for a rather large choledoch stone and the other one for failing to accomplish the papillary intubation. The incidence rate of postoperative complications was7.14%(3/42cases), with a case developing a duodenal bleeding, one case developing an acute pancreatitis, and one case developing an acute cholangitis. There were no statistical differences in the success rate of the operation, the incidence rate of postoperative complications and the time from the recovery of gastrointestinal function to starting eating between the two groups(P>0.05). There were significant statistical differences in the operation time, the bleeding amount and the hospitalization expenses between the two groups (P<0.01). There was no statistical difference in the hepatic function around the operation between the two groups(.P>0.05). There months after the discharge,3to12months’ follow-up of74patients found7short-term recurrent cases of stones by B ultrasound examination, and no death.[Conclusions] l.LCBDE+LC, EST+LC are two kinds of minimally invasive treatment of extrahepatic bile duct stones, and is safe, effective, and feasible if the proper patients are selected.2.Compared with OCBDE, LCBDE+LC has advantages of less trauma, less pain, quicker recovery, smaller scar, and beauty.3. Compared with OCBDE, EST+LC’s request for the diameter of common bile duct is less strict, with advantages of less trauma, shorter hospitalization days, and quicker recovery.4. Compared with LCBDE+LC, EST+LC has advantages of less bleeding amount, shorter operation time, and freedom from carrying a T tube, but its disadvantages are that the cholecystectomy has to be completed in several times, increasing hospitalization expenses, and damaging the function of sphincter of Oddis. And LCBDE+LC protects and keep the function of sphincter of Oddis, but it causes pain of carrying a T tube for long. Both kinds of surgical methods are effective minimally invasive treatments in extrahepatic bile duct stones, with different advantages, and the expected short-term outcome after the operation on the whole is satisfactory, and the clinical doctors can choose a proper one based on specific conditions.