- 作者：Bin Zhu ; Yan Wang ; Ke Gong ; Yiping Lu ; Yu Ren ; Xiaopu Hou ; Ming Song ; Nengwei Zhang
- 关键词：Choledocholithiasis ; Choledochotomy ; Acute cholangitis ; Laparoscopic common bile duct exploration ; Technology assessment
- 刊名：Journal of Surgical Research
- 出版年：March, 2014
- 年：2014
- 卷：187
- 期：1
- 页码：72-76
- 全文大小：182 K
Background
Laparoscopic common bile duct exploration (LCBDE) has already been established for the treatment of patients with common bile duct stones (CBDS) in elective situations. However, the effect of emergent LCBDE on those patients with nonsevere acute cholangitis has not been assessed. The aim of this study was to evaluate the effect of emergent LCBDE on patients with nonsevere acute cholangitis complicated with CBDS.Methods
Seventy-two patients with CBDS admitted from January 2009 to December 2012 were included for this retrospective study. LCBDE of transductal approach for CBDS was performed to all patients. Thirty-seven patients underwent emergent LCBDE for nonsevere acute cholangitis and 35 patients underwent elective LCBDE. Duration of the procedure, complications, retained stone of bile duct, hospital stay, and total charges were compared between the two groups. In addition, the characteristics of patients underwent emergent LCBDE were also compared before and after surgery.
Results
There was no significant difference with regard to the diameter of common bile duct and number of CBDS from imaging and/or operative findings between the two groups. There was no conversion to open common bile duct exploration, no major bile duct injuries, and no mortality in both the group of patients. There was no significant difference in patients with or without acute or chronic cholecystitis, duration of surgery, overall hospital stay (16.41聽卤聽1.03 versus 14.54聽卤聽0.94, P聽>聽0.05), and total charges (18,603聽卤聽1774.64 versus 14,951聽卤聽1257.09 Yuan in renminbi, P聽>聽0.05) between the two groups. Four cases with retained stones were found in patients with emergent LCBDE and two in elective LCBDE patients. There were four cases of biliary leak in patients with emergent LCBDE and three cases in elective LCBDE group, respectively. However, there was no statistical difference between the two groups. The biliary leak was cured postoperatively after drainage. Control of septic symptoms was achieved in all patients after emergent LCBDE.
Conclusions
Our data indicated that emergent LCBDE is as safe and effective as elective LCBDE for the treatment of patients with nonsevere acute cholangitis complicated with CBDS.