The Long-term Follow-up Study On Multiple Mini-invasive Surgical Treatment For Extrahepatic Bile Duce Stones.

Objective:To investigate the relationship between different types of mini-invasive surgical treatment for extrahepatic bile duct stone and its complications, and to explore effective ways to reduce the long-term complications, and to protect the function of Oddi sphincter maximumly through giving a relevant adjustments about indications of different programs. Finally, to offer some valuable suggestions of individual program to clinical treatment for extrahepatic bile duct stone.Methods:Totally 339 patients with extrahepatic bile duct stones treated with program of step-by-step scheme of mini-invasive surgical treatment were treated from Oct. 2000 to Sep.2005. There were 62 cases accepted Endoscopic nasobiliary drainage and Laparoscopic cholecystectomy and common bile duct exploration (GroupⅠof SANJING), and 136 cases underwent Endoscopic sphincterotomy and nasobiliary drainage and Laparoscopic cholecystectomy and common bile duct exploration (GroupⅡof SANJING), and 92 cases accepted Endoscopic sphincterotomy and Laparoscopic cholecystectomy (GroupⅠof ERJING), and 67 cases underwent Laparoscopic cholecystectomy and common bile duct exploration and T-tube drainage (GroupⅡof ERJING). To summarize the long-term complications of these four Strategies and analysis the results of 5 to 10 years (mean 8.3 years) long-term follow-up study.Results:1. There were 7 cases of recurrent bile duct stone in GroupⅠof SANJING (rate 12.28%) and 23 cases in GroupⅠof ERJING (rate 25%); 2 cases of acute cholangitis in GroupⅠof SANJING (rate 3.5%) and 12 cases in GroupⅠof ERJING (rate 13.04%); 2 cases of acute biliary pancreatitis (ABP) in GroupⅠof SANJING (rate 3.51%) and 13 cases in GroupⅠof ERJING (rate 14.13%);3 cases of biliary stricture in GroupⅠof SANJING (rate 5.26%) and 2 cases in GroupⅠof ERJING (rate 2.17%).Both of the two groups were no case of cholangiocarcinoma. The two Groups (p>0.05) is statistically insignificant with regard to biliary stricture, but are statistically significant (p< 0.05) with respect to the other three complications.2.The corresponding complications of GroupⅡof ERJING were as follows: There were 9 cases of recurrent bile duct stone (rate 14.25%); 3 cases of acute cholangitis (rate 4.84%);6 cases of biliary stricture (rate 9.68%); 5 cases of acute biliary pancreatitis (ABP) (rate 8.06%). no case of cholangiocarcinoma. Compared with GroupⅠof SANJING(p>0.05),it is statistically insignificant with regard to all of the four complications.3. The corresponding complications of GroupⅡof SANJING were as follows: 31 cases of recurrent bile duct stone (rate 24.21%); 15 cases of acute cholangitis (rate 11.72%); 16 cases of ABP (rate 12.5%);5 cases biliary stricture (rate 3.9%); Only one case of cholangiocarcinoma. Compared with GroupⅠof SANJING (p>0.05), it is statistically insignificant with regard to biliary stricture, but is statistically significant (p<0.05) with respect to the other three complications.Conclusion:1.The incidence rate of Long-term complications including recurrent bile duct stone, acute cholangitis and ABP of GroupⅠof SANJING were lower than GroupⅠof ERJING and GroupⅡof SANJING. It means that the Oddi's sphincter is very important, and we must control the indications of the program strictly to protect the function of Oddi's sphincter. The patients whose expected life is more than 10 years especially who are younger than 35 years old should better accept Endoscopic nasobiliary drainage and Laparoscopic cholecystectomy and common bile duct exploration. On the contrary, the ones should better accept Endoscopic sphincterotomy and Laparoscopic cholecystectomy. And Laparoscopic common bile duct exploration and T-tube drainage can be chose in the pation who is fail in ERCP and had underwent upper gastrointestinal diversional rsurgery.2. Primary closure of common bile duct is safe and feasible.Because its long-term complications were statistically insignificant comparising with T-tube drainage in GroupⅠof SANJING and GroupⅡof ERJING.3. It can protect the function of Oddi sphincter maximumly to medium or small incision when the stone diameter≤1.0cm.