Laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis in elderly patients

doi:10.3877/cma.j.issn.2095-3232.2016.04.006

Abstract

Abstract:

Objective

To investigate the application value of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) for choledocholithiasis in elderly patients.

Methods

Clinical data of 142 elderly patients with choledocholithiasis in Beijing Hospital between June 2007 and June 2015 were retrospectively analyzed. There were 83 males and 59 females, aged (68±4) years old on average.The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into three groups according to the different surgical procedures: the LTM-CBDE group (n=62), laparoscopic common bile duct exploration group (LCBDE group, n=49) and open common bile duct exploration group (open surgery group, n=31). The operation time and postoperative length of hospital stay among three groups were compared using one way analysis of variance and LSD-t test. The rate was compared using Chi-square test.

Results

All stones were completely removed in three groups and no residual stone was observed. The operation time in the LTM-CBDE group was (155±11) min, which was significantly shorter than (166±10) min in the LCBDE group (LSD-t=-5.043, P<0.05). The postoperative length of hospital stay in the LTM-CBDE group was (5.7±1.1) d , which was significantly shorter than (7.3±1.7) d in the LCBDE group and (8.3±1.9) d in the open surgery group (LSD-t=-5.448, -7.724; P<0.05). The overall incidence of postoperative complications in the LTM-CBDE, LCBDE and open surgery groups was respectively 18% (11/62), 18% (9/49) and 42% (13/31). The overall incidence of postoperative complications in the LTM-CBDE group was significantly lower than that in the open surgery group (χ²=7.777, P<0.05). The incidence of postoperative infection of incision in the LTM-CBDE group was 2%, significantly lower than 13% in the open surgery group (χ²=5.072, P<0.05). No death was observed during the perioperative period. One case of common bile duct stone recurrence was observed respectively in the LTM-CBDE group and LCBDE group during the follow-up, and both were cured by retrograde cholangiopancreatography (ERCP).

Conclusions

LTM-CBDE is a safe and effective treatment for elderly patients with choledocholithiasis with the advantages of short operation time, rapid recovery and less postoperative complications.

Key words: Choledocholithiasis, Laparoscopes, Aged, Perioperative period, Postoperative complications

Jinghai Song, Xiaojuan Niu, Jian Chen, Xiuwen He, Haikong Long, Junmin Wei. Laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis in elderly patients[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(04): 225-229.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2016.04.006

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2016/V05/I04/225

Figures/Tables 4

References 20

[1]	Alkhaffaf B, Parkin E, Flook D. Endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy: a common and potentially hazardous technique that can be avoided[J]. Arch Surg, 2011, 146(3): 329-333.
[2]	Tabone LE, Sarker S, Fisichella PM, et al. To 'gram or not'? indications for intraoperative cholangiogram[J]. Surgery, 2011, 150(4):810-819.
[3]	Wang B, Ding YM, Nie YG, et al. The clinical evaluation of laparoscopic transcystic duct common bile duct exploration in elderly choledocholithiasis [J]. Hepatogastroenterology, 2014, 61(132): 892-896.
[4]	宋京海，陈剑，贺修文，等．腹腔镜下经胆囊管及其汇入部切开胆总管探查术的应用[J]．中国医刊，2011, 46(10): 42-43.
[5]	陈剑，韦军民．术中微切开胆道镜检查的可行性研究[J]．中华肝胆外科杂志，2005, 11(6): 372-374.
[6]	韩威，张忠涛，李建设，等．胆囊管汇入部微切开在腹腔镜胆道探查术中的应用[J]. 中国微创外科杂志，2011, 11(11): 970-972.
[7]	罗昆仑，方征，余锋，等．腹腔镜经胆囊管开口微切开胆管并一期缝合胆管治疗胆囊结石合并胆管结石[J]．中华肝胆外科杂志，2013, 19(5): 349-351.
[8]	Prasson P, Bai X, Zhang Q, et al. One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis[J]. Surg Endosc, 2015, DOI: 10.1007/s00464-015-4657-0[Epub ahead of print].
[9]	Zhang HW, Chen YJ, Wu CH, et al. Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage[J]. Am Surg, 2014, 80(2): 178-181.
[10]	Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after laparoscopic common bile duct exploration[J]. Cochrane Database Syst Rev, 2013(6): CD005641.
[11]	Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery[J]. Ann Intern Med, 2001, 134(8): 637-643.
[12]	Whalley DG, Irefin SA. The anesthetic implications of laparoscopic surgery[M]// Zucker KA. Surgical laparoscopy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2000: 13-28.
[13]	Bàllesta López C, Cid JA, Poves I, et al. Laparoscopic surgery in the elderly patient[J]. Surg Endosc, 2003, 17(2): 333-337.
[14]	Vecchio R, Gelardi V, Persi A, et al. Laparoscopic surgery in the elderly: personal experience in 141 cases[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(6):527-531.
[15]	Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones[J]. J Korean Surg Soc, 2011, 81(2):128-133.
[16]	Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM, et al. Laparoscopic common bile duct exploration in elderly patients: is there still a difference?[J]. Surg Laparosc Endosc Percutan Tech, 2014, 24(4): e118-122.
[17]	Chen XM, Zhang Y, Cai HH, et al. Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration[J]. J Laparoendosc Adv Surg Tech A, 2013, 23(12): 977-981.
[18]	Dong ZT, Wu GZ, Luo KL, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube[J]. J Surg Res, 2104, 189(2):249-254.
[19]	Zhu JG, Zhang ZT. Laparoscopic remnant cholecystectomy and transcystic common bile duct exploration for gallbladder/cystic duct remnant with stones and choledocholithiasis after cholecystectomy[J]. J Laparoendosc Adv Surg Tech A, 2015, 25(1):7-11.
[20]	El Nakeeb A, El Geidie A, El Hanafy E,et al. Management and outcome of borderline common bile duct with stones: a prospective randomized study[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(3): 161-167.

组别	例数	性别		年龄（岁）	身高（cm）	体重（kg）
组别	例数	男	女	年龄（岁）	身高（cm）	体重（kg）
LTM-CBDE组	62	42	20	68±3	168±4	67±6
LCBDE组	49	23	26	68±4	165±3	66±6
开腹组	31	18	13	67±5	165±5	68±7
统计值	?	χ ²=4.880		F=1.530	F=2.680	F=1.147
P值	?	0.087		0.206	0.115	0.320

组别	例数	性别		年龄（岁）	身高（cm）	体重（kg）
组别	例数	男	女	年龄（岁）	身高（cm）	体重（kg）
LTM-CBDE组	62	42	20	68±3	168±4	67±6
LCBDE组	49	23	26	68±4	165±3	66±6
开腹组	31	18	13	67±5	165±5	68±7
统计值	?	χ ²=4.880		F=1.530	F=2.680	F=1.147
P值	?	0.087		0.206	0.115	0.320

组别	例数	心血管疾病（例）	糖尿病（例）	肝脏疾病（例）	肺部疾病（例）	肾功能不全（例）	ASA评分（分）
LTM-CBDE组	62	30	18	4	14	4	2.5±0.3
LCBDE组	49	22	13	2	10	2	2.5±0.3
开腹组	31	15	9	2	6	1	2.4±0.4
统计值	?	χ²=0.157	χ²=0.099	χ²=0.491	χ²=0.152	χ²=0.508	F=1.635
P值	?	0.925	0.952	0.808	0.927	0.787	0.199

组别	例数	心血管疾病（例）	糖尿病（例）	肝脏疾病（例）	肺部疾病（例）	肾功能不全（例）	ASA评分（分）
LTM-CBDE组	62	30	18	4	14	4	2.5±0.3
LCBDE组	49	22	13	2	10	2	2.5±0.3
开腹组	31	15	9	2	6	1	2.4±0.4
统计值	?	χ²=0.157	χ²=0.099	χ²=0.491	χ²=0.152	χ²=0.508	F=1.635
P值	?	0.925	0.952	0.808	0.927	0.787	0.199

组别	例数	手术相关并发症
		胆漏		再发黄疸		切口感染		胆管狭窄
		例数	百分率（%）	例数	百分率（%）	例数	百分率（%）	例数	百分率（%）
LTM-CBDE组	62	3	5	1	2	1	2	1	2
LCBDE组	49	1	2	1	2	2	4	0	0
开腹组	31	2	6	0	0	4	13	0	0
χ²值	?	1.190		0.766		5.072		10414
P值	?	0.659		1.000		0.044		1.000
组别	例数	其他并发症
		心力衰竭		肺炎		尿潴留
		例数	百分率（%）	例数	百分率（%）	例数	百分率（%）
LTM-CBDE组	62	1	2	2	3	2	3
LCBDE组	49	1	2	2	4	2	4
开腹组	31	3	10	3	10	1	3
χ²值	?	3.573		1.928		0.335
P值	?	0.151		0.425		1.000

Please choose a citation manager

Content to export