Background:Laparoscopic common bile duct exploration(LCBDE)is one of the minimally invasive options for choledocholithiasis.Primary closure of the common bile duct(CBD)upon completion of laparoscopic choledochotomy is...Background:Laparoscopic common bile duct exploration(LCBDE)is one of the minimally invasive options for choledocholithiasis.Primary closure of the common bile duct(CBD)upon completion of laparoscopic choledochotomy is safe in selected patients.The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older.Methods:A total of 116 patients(51 males and 65 females)who suffered from choledocholithiasis and underwent primary closure of the CBD(without T-tube drainage)after LCBDE from January 2003 to December 2017 were recruited.They were classified into two groups according to age:group A(≥70 years,n=56),and group B(<70 years,n=60).The preoperative characteristics,intraoperative details,and postoperative outcomes of the two groups were evaluated.Results:The mean operative time was 172.02 min for group A and 169.92 min for group B(P=0.853).The mean hospital stay was 7.40 days for group A and 5.38 days for group B(P<0.001).Bile leakage occurred in two patients in group A and one in group B(3.57%vs 1.67%,P=0.952).There were no significant differences in the rates of postoperative complications and mortality between the two groups.At median follow-up time of 60 months,stone recurrence was detected in one patient in group A and two in group B(1.79%vs 3.33%,P=1.000).Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B(0 vs 1.67%,P=1.000).Conclusion:Primary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients≥70 years old.展开更多
BACKGROUND Endoscopic sphincterotomy(EST) for the management of common bile duct stones(CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that ...BACKGROUND Endoscopic sphincterotomy(EST) for the management of common bile duct stones(CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy(OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIM To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODS Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching(1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic(ROC)curve was generated for qualifying independent risk factors.RESULTS In total, 302 patients undergoing successful EST(n = 168) or OCT(n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT(P <0.001). The number of complete stone clearance sessions increased significantly in the EST group(P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in18.8%(33/176) of the patients overall, but no difference was found between the EST(20.5%, 18/88) and OCT(17.0%, 15/88) groups. Factors as展开更多
目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法...目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法为切开胆总管取净结石,鼻胆管引导器插入胆总管通过十二指肠乳头进入十二指肠,引导器开口指向幽门。内镜活检钳在鼻胆管引导器的导引下进入十二指肠并向上通过幽门到达胃腔,活检钳在胃腔内夹住术前置入的鼻胃管前端的尾状乳胶条,将鼻胃管导入十二指肠、十二指肠乳头进入胆总管,再由鼻胃管引导新型鼻胆管进入十二指肠,最后出外鼻孔。新型鼻胆管头端的环型乳胶弹力圈支撑于肝总管内,一期缝合胆总管。术后5～7 d 拔除鼻胆管。结果 34例术中置新型鼻胆管成功率100%,无一例发生胆漏,拔管时间(5.0±1.5)d、术后住院时间(9.2±1.3)d 较 T 管引流组(分别为15.2±3.6 d、17.1±5.6 d)短,差异有显著性(P<0.01)。结论术中置新型鼻胆管、胆总管一期缝合术适应证广、操作简单、安全可靠,彻底消除了 T 型管引流所致胆漏等并发症,缩短了住院天数,值得进一步推广。展开更多
目的:总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估“两镜”联合治疗胆石症的临床疗效。方法:回顾分析2002年2月至2006年6月行腹腔镜胆总管切开探查、纤维胆道镜取石、胆道扩张及T管引流术(laparo-scop ic choledo...目的:总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估“两镜”联合治疗胆石症的临床疗效。方法:回顾分析2002年2月至2006年6月行腹腔镜胆总管切开探查、纤维胆道镜取石、胆道扩张及T管引流术(laparo-scop ic choledochotomy T-tube drainage,LCTD)患者的临床资料。结果:21例中4例术前行ERCP+EST,手术成功20例,手术时间70-180min,平均120min,1例因术中病理示胆囊粘液腺癌,中转开腹行胆囊癌根治术。18例留置T管。患者术后第1天均可下床活动和进食,术后12d行T管造影夹闭T管。术后30-40d(平均34d)拔除T管,2例发生胆漏,其余病例无胆道狭窄、胆道出血和残余结石等手术并发症。1例术后2个月胆管结石复发经T管窦道取石。结论:腹腔镜胆总管探查术具有创伤轻、患者痛苦小、康复快、腹腔脏器干扰少等优点,同时能取得与开腹手术相同的治疗效果,是目前微创治疗胆囊结石并复杂性胆管结石较理想的方法。展开更多
文摘Background:Laparoscopic common bile duct exploration(LCBDE)is one of the minimally invasive options for choledocholithiasis.Primary closure of the common bile duct(CBD)upon completion of laparoscopic choledochotomy is safe in selected patients.The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older.Methods:A total of 116 patients(51 males and 65 females)who suffered from choledocholithiasis and underwent primary closure of the CBD(without T-tube drainage)after LCBDE from January 2003 to December 2017 were recruited.They were classified into two groups according to age:group A(≥70 years,n=56),and group B(<70 years,n=60).The preoperative characteristics,intraoperative details,and postoperative outcomes of the two groups were evaluated.Results:The mean operative time was 172.02 min for group A and 169.92 min for group B(P=0.853).The mean hospital stay was 7.40 days for group A and 5.38 days for group B(P<0.001).Bile leakage occurred in two patients in group A and one in group B(3.57%vs 1.67%,P=0.952).There were no significant differences in the rates of postoperative complications and mortality between the two groups.At median follow-up time of 60 months,stone recurrence was detected in one patient in group A and two in group B(1.79%vs 3.33%,P=1.000).Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B(0 vs 1.67%,P=1.000).Conclusion:Primary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients≥70 years old.
文摘BACKGROUND Endoscopic sphincterotomy(EST) for the management of common bile duct stones(CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy(OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIM To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODS Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching(1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic(ROC)curve was generated for qualifying independent risk factors.RESULTS In total, 302 patients undergoing successful EST(n = 168) or OCT(n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT(P <0.001). The number of complete stone clearance sessions increased significantly in the EST group(P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in18.8%(33/176) of the patients overall, but no difference was found between the EST(20.5%, 18/88) and OCT(17.0%, 15/88) groups. Factors as
文摘目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法为切开胆总管取净结石,鼻胆管引导器插入胆总管通过十二指肠乳头进入十二指肠,引导器开口指向幽门。内镜活检钳在鼻胆管引导器的导引下进入十二指肠并向上通过幽门到达胃腔,活检钳在胃腔内夹住术前置入的鼻胃管前端的尾状乳胶条,将鼻胃管导入十二指肠、十二指肠乳头进入胆总管,再由鼻胃管引导新型鼻胆管进入十二指肠,最后出外鼻孔。新型鼻胆管头端的环型乳胶弹力圈支撑于肝总管内,一期缝合胆总管。术后5～7 d 拔除鼻胆管。结果 34例术中置新型鼻胆管成功率100%,无一例发生胆漏,拔管时间(5.0±1.5)d、术后住院时间(9.2±1.3)d 较 T 管引流组(分别为15.2±3.6 d、17.1±5.6 d)短,差异有显著性(P<0.01)。结论术中置新型鼻胆管、胆总管一期缝合术适应证广、操作简单、安全可靠,彻底消除了 T 型管引流所致胆漏等并发症,缩短了住院天数,值得进一步推广。
文摘目的:总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估“两镜”联合治疗胆石症的临床疗效。方法:回顾分析2002年2月至2006年6月行腹腔镜胆总管切开探查、纤维胆道镜取石、胆道扩张及T管引流术(laparo-scop ic choledochotomy T-tube drainage,LCTD)患者的临床资料。结果:21例中4例术前行ERCP+EST,手术成功20例,手术时间70-180min,平均120min,1例因术中病理示胆囊粘液腺癌,中转开腹行胆囊癌根治术。18例留置T管。患者术后第1天均可下床活动和进食,术后12d行T管造影夹闭T管。术后30-40d(平均34d)拔除T管,2例发生胆漏,其余病例无胆道狭窄、胆道出血和残余结石等手术并发症。1例术后2个月胆管结石复发经T管窦道取石。结论:腹腔镜胆总管探查术具有创伤轻、患者痛苦小、康复快、腹腔脏器干扰少等优点,同时能取得与开腹手术相同的治疗效果,是目前微创治疗胆囊结石并复杂性胆管结石较理想的方法。
