| Objective: Gallstone is a common disease of hepatobiliary surgery,and often combined with common bile duct stones,and small common bile duct stones is a special type of common bile duct stones,the treatment of small common bile duct stones is more difficult because of the common bile duct diameter ? 8mm.In the past,more choices for laparotomy for treatment,but the development of minimally invasive techniques makes small diameter common bile duct stones also could treated by minimally invasive.Laparoscopic common bile duct exploration(LCBDE)was first applied to the treatment of choledocholithiasis by the end of the 20 th century.This method can avoid the huge trauma caused by open surgery and could open the bile duct under laparoscopy then use the choledochoscope to exploration the common bile duct.If it is difficult to remove a large stone,the holmium laser can be used to remove the stone.Laparoscopic cholecystectomy(LC)combined with LCBDE has been widely used in the treatment of patients with cholecystolithiasis and choledocholithiasis.The purpose of this study was to explore the feasibility and safety of LC combined with LCBDE for the treatment of cholecystolithiasis combined with small diameter common bile duct stones.Methods: Clinical data of 157 cases of cholecystolithiasis with choledocholithiasis treated by LC combined with LCBDE in the general surgery department of the Fourth Affiliated Hospital of China Medical University from May 2014 to December 2016 were retrospectively analyzed.Large diameter choledocholithiasis in 109 cases of large diameter group(common bile duct diameter> 8mm),small diameter choledocholithiasis in 48 cases of small diameter group(5mm ? common bile duct diameter ? 8mm).The indexes of operation time,intraoperative blood loss,operation rate,stone removal rate,postoperative complications and so on were compared between the two groups.Postoperative follow-up was performed in both groups.Result: The operation time of the large diameter group and the small diameter group was(170.0 ± 58.3min vs.167.5 ± 64.6min,P> 0.05).In the large diameter group,6 cases were converted to laparotomy,2 cases were converted to laparotomy in small diameter group,the operation transfer rate of the large diameter group and the small diameter group was(5.5% % vs.4.2%,P> 0.05).In the large diameter group,84 cases of common bile duct stones were completely removed,40 cases of common bile duct stones were removed in the small diameter group,the stone clearance rate was(77.1% vs 83.3%,P>0.05).Complications were found in 9 cases of the large diameter group,Complications were observed in 3 cases of small diameter group after operation,but no serious complications such as deaths.The postoperative complication rate of the large diameter group and the small diameter group was(8.3% vs.6.3%,P> 0.05).The above indicators were no significant difference.The difference of the intraoperative blood loss(61.2±18.0ml vs.63.8±15.2ml),exhaust time(2.4±0.8d vs.2.2±0.7d),hospital stay(16.4±7.5d vs.17.5±6.6d),hospital costs(38059.7±11740.5yuan vs.36207.5±8479.7yuan)between large diameter group and small diameter group was not statistically significant.The patients with large diameter and small diameter were followed up for an average of20 months(range 5-26 months)with no biliary stricture.Conclusion: The treatment of gallbladder stones combined with small diameter choledocholithiasis by LC combined with LCBDE would not increase the operation time or increase the operation transfer rate and postoperative complications.There was no significant difference between the operation and postoperative indexes in two group.There was no biliary stricture in patients about the small diameter group during follow-up.Therefore,LC combined with LCBDE is feasible,effective and safe for the treatment of cholecystolithiasis with small diameter choledocholithiasis when conditions permit. |
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