Laparoscopic And New Type Of Rigid Choledochoscopic Cholecystolithotomy And Laparoscopic Cholecystectomy: Retrospective And Analysis Of105Cases

Objective: To explore the feasibility and application prospect oflaparoscopic and new type of rigid choledochoscopic （CHiAO）cholecystolithotomy by comparing with homochronous laparoscopiccholecystectomy.Method: A total of105patients with cholelithiasis were enrolled in aretrospective study from June,2012to October,2013. Confirmed diagnosis wasmade through ultrasonic and CT examinations of the upper abdomen. Allpatients were admitted in the Department of General Surgery, Nanning2ndPeople’s Hospital, and underwent surgical treatment. Among them,42casesunderwent laparoscopic and rigid choledochoscopic cholecystolithotomy (LRCLgroup), during which intraoperative ultrasonic examination was adopted toreconfirm the condition of the gallstone; the other63cases underwentconventional laparoscopic cholecystectomy (laparoscopic cholecystectomygroup, LC group). Comparative analysis was made between the two groups ontime of operation, intraoperative amount of bleeding and postoperative time of anal exhaust, overall hospital stays, overall hospitalization expense,post-discharge complications and post-discharge quality of life.Results: All operations for both groups went on successfully with no casesrequiring laparotomy. Cholecystectomy in LC group was successfully performedwithout choledochal injury or bile leakage. Through the intraoperative ultrasonicexaminations, in the LRCL group, we identified18cases that were combinedwith calculus in neck and duct of the gallbladder, in which12cases hadincarcerated calculus in neck and duct of the gallbladder. No significantdifferences were displayed between the two groups postoperative time of analexhaust（P＞0.05）. The operation time and the intraoperative amount ofbleeding of LRCL group is shorter than that of LC group, the difference isstatistically significant(P＜0.05）. For the indicators evaluating postoperativerecovery, the postoperative hospital stays, the overall hospitalization expenseand complications of LRCL group are less than that of LC group, the differencesare statistically significant(P<0.05). The follow-up B ultrasonic examinations at3months to1year after operation revealed no residual calculus, secondary bileleakage, acute cholecystitis or biliary tract obstruction in LRCL group. No casesrecured calculus of intrahepatic duct and of common bile duct in LC group.After all patients were discharged,51cases of LC group had suffered dyspepsia,diarrhoea, or midsection pain. But to LRCL group, there were only4patientsexperienced the same symptom, which means significantdifferences(2=51.545，P＜0.01). There were6patients in LRCL group and55patients in LC group considered that their daily diets been influenced by theiroperation, which also means significant differences (2=55.186，P＜0.01).Conclusion: The application of CHiAO choledochoscopiccholecystolithotomy intraoperative ultrasonic examination could facilitate cholecystolithotomy by providing surgeons with real-time, accurate andcomprehensive knowledge of the distribution of the calculus in the gallbladder,making the surgical procedure no longer in complete darkness. The applicationof new choledochoscopy combined with intraoperative ultrasound makes theoperation not only performed via naked eyes, but also more precise, assuring thesuccess rate and reducing the residual calculus. There was no statisticaldifference in hospitalization expense between the two groups, but once thepatient’s gallbladder was preserved, it would greatly reduce complicationsresulted from cholecystectomy such as diarrhea, dyspepsia or etc.(Postcholecystectomy syndrome，PCS), largely promoting the quality of life. Tocompare with LC, patients more likely to accept cholecystolithotomy if possible,which offer big market value to hospital to develop cholecystolithotomy.However, what must be pointed out is, this research have its own limits. Thetime of follow-up in LRCL group is too short to acheive a satisfy observation, sothat the recurrence rate of both group and the long-term complications are not beobserved effectively. Therefore, it still need more follow-up time and data toconfirm the further clinical value and foreground of CHiAOcholecystolithotomy. For the patients who did not fit for LRCL, LC is no doubtthe best therapy for them.