Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bile
duct exploration through mini-incision in confluence of common bile duct (CBD) and cystic duct.
Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct, and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy, the incision was sewed up by T-tube free primary suture.
Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation, intraoperative
cholangiography, removal of stones with help of choledochoscope, and removal drainage tube after operation was from 90 to 200 min with an average of 100min, 3 to 10min with an average of 6min, 5 to 15 min with an average of 8 min,
and 3-5d with an average of 3.5d , respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage, abdominal pain, and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months.
Conclusion With proper patient selection, T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Citation:
LU Tiecheng,ZHOU Tianmin,WU Shangwei. Feasibility Through Confluence of Common Bile Duct and Cystic Duct Approach with Mini-Incision in LaparoscopicCommon Bile Duct Exploration. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1287-1289. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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- 1. 王源荣, 朱月清, 夏存林, 等. 胆总管探查术式的选择和决策[J]. 腹腔镜外科杂志, 2009, 14(4):293-295.
- 2. 冯作忠. 经胆囊管行术中胆道镜胆道探查68例分析[J]. 中国普外基础与临床杂志, 2008, 15(3):208-209.
- 3. 胡三元. 肝内、外胆管结石的腹腔镜处理[J]. 中国普外基础与临床杂志, 2008, 15(10):711-713.
- 4. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial[J]. J Surg Res, 2009, 157(1):e1-e5. doi:10.1016/j. jss. 2009. 03. 012.
- 5. Ahmed I, Pradhan C, Beckingham IJ, et al. Is a T-tube necessaryafter common bile duct exploration?[J]. World J Surg, 2008, 32(7):1485-1488. doi:10.1007/s00268-008-9475-2.
- 6. Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus T-tube drainage after open choledochotomy[J]. Asian J Surg, 2009, 32(1):21-25.
- 7. 孙利国, 刘小敏. 胆总管切开取石Ⅰ期缝合64例报道[J]. 中国普外基础与临床杂志, 2007, 14(1):109.
- 8. 胡晋太, 蔡晚霞, 胥丹, 等. 腹腔镜胆总管探查术的临床应用[J]. 腹腔镜外科杂志, 2012, 17(1):53-55.
- 9. Corbett CR, Fyfe NC, Nicholls RJ, et al. Bile peritonitis after removal of T-tubes from the common bile duct[J]. Br J Surg, 1986, 73(8):641-643.
- 10. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophag-omyotomy. Initial experience with a new approach for the treatment of achalasia[J]. Ann Surg, 1992, 216(3):291-296.
- 11. 陈德兴, 刘奇, 董加纯, 等. 腹腔镜下经胆囊管切开胆总管取石胆道一期缝合术[J]. 中国微创外科杂志, 2010, 10(11):1013-1015.
- 12. 吴国忠, 莫晓东, 陆春雷, 等. 胆总管结石的微创处理策略选择[J]. 腹腔镜外科杂志, 2009, 14(1):65-66.
- 13. 牟一平, 牟永华. 腹腔镜胆总管探查一期缝合[J]. 肝胆外科杂志, 2009, 17(3):168-169.
- 14. 汤庆峰, 戴德祥, 王绍勇, 等. 腹腔镜胆总管探查取石术的临床体会[J]. 中国普外基础与临床杂志, 2010, 17(12):1302-1304.
- 15. 张雷达, 别平, 陈平, 等. 腹腔镜胆道探查术后胆管一期缝合与T管引流的疗效比较[J]. 中华外科杂志, 2004, 42(9):520-523.
- 16. 高静涛, 秦建伟, 袁克文, 等. 腹腔镜胆管切开一期缝合及胆囊管导管的联合应用[J]. 肝胆外科杂志, 2007, 15(2):124-126.
- 17. 王京立, 杨敖霖, 陆春雷. 腹腔镜胆总管探查、一期缝合的应用研究[J]. 中国微创外科杂志, 2006, 6(1):19-20.
- 18. Etala E著, 刘青光, 王自法主译. 胃肠手术技巧图谱[M]. 西安:世界图书出版西安公司, 2000:96-97.
- 19. 何海山, 秦涛, 付小兰. 腹腔镜胆囊切除术中胆道造影的临床应用[J]. 中国当代医药, 2010, 17(7):39-40.
- 20. 李宁, 徐涛, 吴可人, 等. 术中胆道造影在腹腔镜胆囊切除术中的应用价值[J]. 肝胆胰外科杂志, 2005, 17(3):215-216.
- 21. 杨晓军, 高鹏, 司若湟, 等. 常规/选择性胆道造影在腹腔镜胆囊切除术中的应用研究[J]. 中国普外基础与临床杂志, 2012, 19(10):1105-1109.