To explore the application value of common bile duct re-exploration under laparoscope combined with choledochoscope in patients with intra- and extrahepatic bile duct stone.

Clinical data of 79 patients with intra- and extrahepatic bile duct stone who had previous operative history of biliary tract in Zhongshan Hospital Affiliated to Fudan Univesity between June 2014 and May 2016 were retrospectively analyzed. According to the treatment method, the patients were divided into the laparoscope combined with choledochoscope group (two-scope group) and laparotomy group. There were 43 cases in two-scope group, including 18 males and 25 females with the average age of (63±14) years. There were 36 cases in laparotomy group, including 19 males and 17 females with the age of (63±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received. The operation time and hospitalization expenses of two groups were compared by t test. The intraoperative blood loss, postoperative recovery time of gastrointestinal tract were compared by Z test. The incidence of complications was compared by Chi-square test or Fisher's exact probability method.

The operation time of patients in two-scope group was (5.2±1.8) h, significantly longer than (2.4±1.3) h of the laparotomy group (t=7.371, P<0.05). The median of intraoperative blood loss in two-scope group was 30(5-200) ml and was 40(10-400) ml in laparotomy group, and no significant difference was observed (Z=-0.270, P>0.05). The postoperative recovery time of gastrointestinal tract and postoperative hospitalization time in two-scope group was 3(1-9) and 8(3-18) d respectively, and was 3(1-29) and 9(2-97) d in laparotomy group, and no significant difference was observed (Z=-1.475, -2.023; P>0.05). The hospitalization expenses of the two-scope group was 34(7-96) thousand yuan, significantly more than 28(14-96) thousand yuan of the laparotomy group (Z=2.495, P<0.05). The postoperative residual rate of stone, incidence of bile leakage and incision infection of the two-scope group was respectively 12%(5/43), 0 and 0, and was 19%(7/36), 6%(2/36) and 3%(1/36) in laparotomy group, and no significant difference was observed (P>0.05).

Laparoscope combined with choledochoscope is a safe and effective operation for intra- and extrahepatic bile duct stone with previous operative history of biliary tract.