| Background: With the rapidly growing popularity of laparoscopicequipment, the spread of laparoscopic technology, especially thegrass-roots hospitals to carry out laparoscopic surgery, laparoscopiccholecystectomy(LC) has become the preferred means of treatment ofbenign gallbladder disease. Minimally invasive treatment has been firmlyestablished. It has been accepted by the majority of patients due to itscharacteristics such as trauma, quicker recovery, leaving no obvious scarand so on. With indications of LC expanding, the number of cases of LChas greatly increased in hospitals at all levels. As the economic conditionsin part of patients, the necessary preoperative examination is sometimesdifficult to cover all patients, and the level of inspection facilities fromdifferent hospitals are varied, leading to the disparity of sensitivity intesting choledocholith. So some choledocholithes can not be detected inthe preoperative. Some small pieces of calculus in gallbladder wouldhappen to fall into the common bile duct LC. This type of stones isdifficult to be noticed because there is no indication of bile ductexploration, and routine intraoperative cholangiographies will not onlyincrease patients’ unnecessary financial burden but longer surgery time aswhile. However, choledocholithiasis will inevitably lead to clinicalsymptoms, so reports of residual stones in common bile duct after LC areincreasing year by year following by the patients’ visiting again. Residualstones in the common bile duct have become an important problem whichsurgeons have to face. Scholars have proposed a variety of means toprevent residual stones in the common bile duct, such as adding thepreoperative examination, focus on operational details of the surgery, but residual stones in the common bile duct still can not be completelyavoided. Choosing the treatment for residual stones in the common bileduct is one of the hot spots we are exploring in recent years. In traditional,we often explore the bile duct to treat choledocholithes, but after thesurgery on gallbladder, adhesions are usually very heavy. It will beextremely difficult to actualize LCBDE, in fact, we often choose CBDEto treat residual stones in the common bile duct. CBDE is often criticizeddue to its larger traumatic, longer treatment cycle, and the possibility ofbile fistula, wound infection, the T tube off and other complications. Inrecent years, with the gradual development of endoscopic techniques andphysician increasing their operating levels, ERCP for choledocholithiasishas been popularized. And yet, pancreatitis and regurgitation of bile ductdue to EST gradually cause doctors’ attention. And a large quantity stonesor a larger single stone may result in hard to be removed at one singletime. So the patient may suffer from another ERCP. Therefore, we cansay that the two treatment methods both have advantages anddisadvantages. In this regard, this dissertation lists the medical effect of61cases of patients with residual stones in common bile duct as anexample to make a comparison.Objective: Compare the surgical outcomes of ERCP and CBDE forresidual stones in common bile duct after LCMethods: Review and analysis cases turned out to have residualstones in common bile duct after LC around recent9years(2004.1-2013.3).Twenty-nine of them were treated by CBDE and anotherthirty-two by ERCP. We compare the postoperative average of hospitalstay as well as the sort and incidence of complications.Results: These two treatments are different from the postoperativeaverage of hospital stay, but they show no differences in the incidence ofcomplications. Conclusion: CBDE has a longer postoperative average of hospitalstay, therefore ERCP has important application value in treating residualstones in common bile duct after LC. It is an effective interventionmethod, generally superior to CBDE. But more attention should be paidon patients who have multiple calculus or a single stones with larger sizeif you decide to treat him with ERCP. CBDE should also be considered ifnecessary. |
PDF Full Text Request