Evaluation of effect of endoscopic retrograde cholangiopancreatography and laparoscopic bile duct exploration lithotomy in treatment of intra/extra-hepatic duct stones
10.3969/j.issn.1007-1989.2017.08.007
- VernacularTitle:经内镜逆行胰胆管造影术与腹腔镜胆道手术在肝内外胆管结石治疗中的疗效评价
- Author:
Huajian GU
;
Yuting GUO
;
Min HAN
;
Chao YU
;
Zili CHEN
;
Yaozhen PAN
;
Chengyi SUN
- Keywords:
intrahepatic duct stones;
common bile duct stones;
endoscopic retrograde cholangiopancreatography (ERCP);
endoscopic sphincterotomy (EST);
laparoscopic bile duct exploration lithotomy (LBDEL)
- From:
China Journal of Endoscopy
2017;23(8):32-37
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic bile duct exploration lithotomy (LBDEL) in treatment of intra/extra-hepatic duct stones. Methods There were 110 patients whose intrahepatic stones located in Ⅰ , Ⅱ hepatic duct and 378 patients whose stones only located in the common bile duct. These patients respectively underwent LBDE combined with choledochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to remove the stones. Common bile ducts were performed primary suture or T tube placement in the LBDEL cases. The evaluation was carried out for perioperative complications and postoperative recovery of the surgical methods. Results The residual stone rate was 31.82% in 110 cases. The rate was higher in ERCP group (51.06%) than that in LBDEL group (17.46%) (P < 0.05). Postoperative recovery was better in LBDEL group than that in ERCP group. The residual stone rate was 8.20% in 378 cases. The rate was lower in ERCP group (3.68%) than that in LBDEL group(11.63%) (P < 0.05). Between the two groups, there had no statistical significance in postoperative recovery. The incidences of bile leakage and pulmonary infection were higher in LBDEL group than in ERCP group. The incidences of abdominal cavity infection, acute pancreatitis, digestive tract perforation and gastrointestinal bleeding were higher in ERCP group than that in LBDEL group. 2 of the 378 patients occurred death were happened digestive tract perforation which were induced during ERCP procedure. Conclusion LBDEL and ERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones. However, ERCP has no large advantages in the treatment of hepatolithiasis, and shows higher complication rates. LBDEL has a significant curative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter. This technology is easy to spread to the basic-level hospital to benefit the majority of patients.
