Clinical Study On Laparoscopic Common Bile Duct Exploration Combined Choledochoscopic Examination

Objective: To explore the technical highlights and limitations of laparoscopic common bile duct exploration combined choledochoscopic examination.Methods: We collected 43 patients received laparoscopic common bile duct exploration(1aparoscopic common bile duct exploration, LCBDE) in Tongling People's Hospital from Jan 2012 to Dec 2014. The clinical data were collected. The linical manifestations, preoperative diagnosis, surgical options, operation time, stone quantity, main technical points, treatment effect, complication and residue rate were recorded. The technical highlights and limitations of LCBDE combined choledochoscopic examination were anlyzed.Results: With 20 males and 23 females, the median age of these 43 cases was 53 years. The main clinical manifestations were right upper quadrant or epigastric pain in 39 patients, jaundice in 28 cases and fever in 24 cases. 13 cases had a history of biliary surgery, with gallbladder removed. Preoperative diagnosis including 35 cases of common bile duct(CBD) stones(25 cases with single stone and 10 cases with multiple stones) and 8 cases of the left intrahepatic bile duct multiple stones combined CBD stones; gallbladder stones were found in 25 cases. The maximum diameter of the bile duct stones was 2 cm. All cases underwent four-port LCBDE, intraoperative choledochoscope was used in all patients and baskets were used to take out the stone. Laparoscopic cholecystectomy was performed in 30 patients with gallbladder, and laparoscopic hepatic left lateral lobectomies were performed in 5 of 8 patients with intrahepatic bile duct stones. Two cases were converted to open surgery due tothe stones were incarcerated in the inferior extremity of CBD and could not been removed using LCBDE. The other 2 cases of laparoscopic lobectomies were also converted to open surgery due to intraoperative widespread bleeding. The success rate is 90.7%(39/43), and conversion rate is 9.3%(4/43). T-tube drainage placed in 32 of 39 cases, primary sutures were performed in 7 cases. The mean operative time was(132.0 ± 38.5) minutes. Etherpuncture infection or residual stones are found in 2 cases, complication rate are 10.3%(4/39).Conclusions: LCBDE is a kind of minimally invasive surgery, with less intraoperative bleeding and complication rate, patients can recover quickly. The indications include gall bladder and CBD stones, but not for complex or intra-and extrahepatic bile duct stone or impacted bile duct stones. They are necessary nessesary to enhance the technical levels of laparoscope and choledochoscope and use some intraoperative lithotripsy in order to further improve the success rate.