PTCD combined with laparoscopic common bile duct exploration and primary duct closure in treating patients presenting with acute cholangitis due to common bile duct stones
10.3760/cma.j.cn113884-20210225-00070
- VernacularTitle:序贯治疗胆总管结石合并胆囊结石伴急性胆管炎的疗效分析
- Author:
Xueme DING
1
;
Xiangtao WANG
;
Xinliang KONG
;
Shangsheng LI
;
Jun GAO
;
Shan KE
;
Shaohong WANG
;
Jian KONG
;
Yinming ZHOU
;
Qiang LI
;
Wenbing SUN
Author Information
1. 首都医科大学附属北京世纪坛医院健康体检中心，北京 100038
- Keywords:
Choledocholithiasis;
Percutaneous transhepatic cholangial drainage;
Biliary exploration;
Primary duct closure
- From:
Chinese Journal of Hepatobiliary Surgery
2021;27(7):513-516
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the results of using a sequential menagement of conservative treatment, percutaneous transhepatic cholangial drainage(PTCD), laparoscopic cholecystectomy(LC) combined with laparoscopic common bile duct exploration(LCBDE) and primary duce closure(PDC) in patients with cholecystolithiasis and common bile duct stone(CBDS) who presented with acute cholangitis.Methods:The clinical data of 397 patients with CBDS and cholecystolithiasis who presented with acute cholangitis from January 2015 to August 2020 were retrospectively analyzed, including 230 patients from the West Campus, Beijing Chaoyang Hospital, Capital Medical University, 95 patients from the Second People's Hospital of Binzhou and 72 patients from Rizhao Central Hospital. Conservative treatment, PTCD and LC+ LCBDE+ PDC were used sequentially. The interval between PTCD and LCBDE, the decrease of serum total bilirubin and alanine aminotransferase after PTCD, the operative time of LC+ LCBDE+ PDC, and the intraoperative blood loss were analyzed. Postoperative indwelling time of abdominal drainage tube and PTCD tube time, postoperative hospital stay, postoperative complications, etc.Results:These were 15 males and 18 femals with the mean age of 57.5 years old. The mean serum total bilirubin and alanine aminotransferase levels decreased from (148.3±36.8) μmol/L and (172.6±26.9) U/L before PTCD to (32.6±5.9) μmol/L and (45.7±7.2) U/L after PTCD, respectively. The interval between PTCD and LCBDE was (25.3±2.6) d. The operation time of LC+ LCBDE+ PDC was (95.4±14.2) min. The intraoperative blood loss was (35.2±9.5 )ml and the mean postoperative hospital stay was (12.4±3.5) d. The postoperative indwelling time of abdominal drainage tubes and PTCD tubes were (10.6±2.3) d and (25.8±4.7) d, respectively. After surgery, bile leakage occurred in 3 patients (9.1%), abdominal hemorrhage in 1 patient (3.0%), biliary bleeding in 1 patient (3.0%), navel incision infection in 1 patient (3.0%), lower common bile duct stenosis in 2 patients (6.1%). All complications responded well to conservation treatment.Conclusions:Sequential treatment using conservative treatment, PTCD combined with LC+ LCBDE+ PDC in patients with cholecystolithiasis and CBDS who presented with acute cholangitis was safe, and efficacious using the minimally invasive approach. This approach is worth promoting to other centers.
