Efficacy of laparoscopic cholecystectomy combined with ultra-thin choledochoscope in the treatment of cystic duct stones

doi:10.3877/cma.j.issn.2095-3232.2026.02.010

Abstract

Abstract:

Objective

To evaluate the clinical application value of laparoscopic cholecystectomy (LC) combined with ultra-thin choledochoscope in the treatment of cystic duct stones.

Methods

Clinical data of 62 patients with cystic duct stones who underwent LC in the First Affiliated Hospital of Anhui University of Science and Technology from September 2021 to September 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 50 female, aged from 24 to 80 years, with a median age of 54 years. According to whether ultra-thin choledochoscope was adopted during LC, 26 patients were assigned into the ultra-thin choledochoscope group and 36 cases in the control group. For all patients, "four-port LC" was performed by the same team. Intraoperative and postoperative recovery, the presence of residual stones and secondary common bile duct stones were compared between two groups. Operation time and hospitalization expenses were compared by t-test between two groups. The incidence of complications was compared by Fisher's exact test.

Results

The operation time in the ultra-thin choledochoscope group was (77±16) min, significantly longer than (66±16) min in the control group (t=2.689, P=0.009). The hospitalization expense in the ultra-thin choledochoscope group was (1.3±0.1)×10⁴ yuan, significantly higher than (1.2±0.1)×10⁴ yuan in the control group (t=2.388, P=0.020). No abdominal bleeding, bile leakage and incision infection occurred after operation in two groups. In the control group, 2 cases developed residual stones in the cystic duct and 4 cases of secondary common bile duct stones, whereas none in the ultra-thin choledochoscope group. The difference between two groups was statistically significant (both P<0.05).

Conclusions

LC combined with ultra-thin choledochoscope prolongs operation time and increase hospitalization expenses for patients with cystic duct stones, but it can effectively reduce the risk of postoperative residual stones and enhance surgical safety, especially for patients with multiple stones or fragmented stones in the cystic duct.

Key words: Cholelithiasis, Cystic duct stones, Cholecystectomy,laparoscopic, Superfine choledochoscope

Manman Lu, Qizhu Feng, Jie Sun, Jian Zhang. Efficacy of laparoscopic cholecystectomy combined with ultra-thin choledochoscope in the treatment of cystic duct stones[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 205-210.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2026.02.010

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2026/V15/I02/205

Figures/Tables 5

指标	超细胆道镜组	对照组	统计值	P值
性别(例, 男/女)	5/21	7/29	χ²=0.000	0.983
年龄(岁, $x ¯$ ±s)	55±16	56±12	t=-0.307	0.760
BMI(kg/m², $x ¯$ ±s)	24±3	23±4	t=0.769	0.374
吸烟史(例)	4	5	χ²=0.027	0.869
饮酒史(例)	6	8	χ²=0.006	0.937
高血压病史(例)	5	8	χ²=0.082	0.775
糖尿病病史(例)	6	11	χ²=0.424	0.515
胆囊壁厚度(mm, $x ¯$ ±s)	3.86±0.62	3.94±0.55	t=-0.841	0.129
胆囊管结石数量≥ 2枚(例)	15	18	χ²=0.359	0.549
ALT[U/L, M(Q₁, Q₃)]	43(26, 54)	40(33, 52)	Z=0.235	0.814
AST[U/L, M(Q₁, Q₃)]	50(37, 67)	37(30, 53)	Z=1.842	0.066

指标	超细胆道镜组	对照组	统计值	P值
性别(例, 男/女)	5/21	7/29	χ²=0.000	0.983
年龄(岁, $x ¯$ ±s)	55±16	56±12	t=-0.307	0.760
BMI(kg/m², $x ¯$ ±s)	24±3	23±4	t=0.769	0.374
吸烟史(例)	4	5	χ²=0.027	0.869
饮酒史(例)	6	8	χ²=0.006	0.937
高血压病史(例)	5	8	χ²=0.082	0.775
糖尿病病史(例)	6	11	χ²=0.424	0.515
胆囊壁厚度(mm, $x ¯$ ±s)	3.86±0.62	3.94±0.55	t=-0.841	0.129
胆囊管结石数量≥ 2枚(例)	15	18	χ²=0.359	0.549
ALT[U/L, M(Q₁, Q₃)]	43(26, 54)	40(33, 52)	Z=0.235	0.814
AST[U/L, M(Q₁, Q₃)]	50(37, 67)	37(30, 53)	Z=1.842	0.066

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	住院时间(d, $x ¯$ ±s)	住院费用(万元, $x ¯$ ±s)
超细胆道镜组	26	77±16	10(9, 15)	6.6±2.1	1.3±0.1
对照组	36	66±16	10(5, 10)	7.4±2.8	1.2±0.1
统计值		t=2.689	Z=1.800	t=-1.275	t=2.388
P值		0.009	0.072	0.207	0.020

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	住院时间(d, $x ¯$ ±s)	住院费用(万元, $x ¯$ ±s)
超细胆道镜组	26	77±16	10(9, 15)	6.6±2.1	1.3±0.1
对照组	36	66±16	10(5, 10)	7.4±2.8	1.2±0.1
统计值		t=2.689	Z=1.800	t=-1.275	t=2.388
P值		0.009	0.072	0.207	0.020

References 25

[1]	Kohga A, Suzuki K, Okumura T, et al. Presence of cystic duct stone is a risk for postoperative retained stones in patients with acute cholecystitis[J]. Clin Imaging, 2022, 89: 55-60.DOI: 10.1016/j.clinimag.2022.06.001.
[2]	Li Y, Zhang L, Hou S. Cystic duct stones in postcholecystectomy Mirizzi syndrome-A novel endoscopic treatment[J]. Rev Esp Enferm Dig, 2022, 114(9): 557-558.DOI: 10.17235/reed.2022.8802/2022.
[3]	Pawa R, Dorrell R, Pawa S. Endoscopic management of cystic duct stones and Mirizzi's syndrome: experience at an academic medical center[J]. Endosc Int Open, 2022, 10(1): E135-E144.DOI: 10.1055/a-1594-1515.
[4]	Guo X, Fan Q, Guo Y, et al. Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC[J]. BMC Gastroenterol, 2024, 24(1): 28.DOI: 10.1186/s12876-023-03117-3.
[5]	冯其柱, 徐喆, 孙杰, 等. 经外周静脉和胆囊注射吲哚菁绿在腹腔镜困难胆囊切除术中应用效果对比[J]. 实用医学杂志, 2024, 40(11): 1537-1541, 1548.DOI: 10.3969/j.issn.1006-5725.2024.11.012.
[6]	Sharma S, Sood R, Garg A, et al. Rouviere's sulcus analysis: a critical safety analysis and a guide to safe laparoscopic cholecystectomy[J].Cureus, 2023, 15(5): e39385.DOI: 10.7759/cureus.39385.
[7]	Ibrarullah M, Mohanty L, Mishra A, et al. Anatomical appraisal of safe cholecystectomy: a prospective study[J]. ANZ J Surg, 2023, 93(5): 1329-1334.DOI: 10.1111/ans.18387.
[8]	Yang MJ, Park DH. A stone in remnant cystic duct causing mirizzi syndrome following laparoscopic cholecystectomy[J]. Clin Endosc, 2021, 54(5): 777-779.DOI: 10.5946/ce.2021.205.
[9]	O'Rear J, Wong P, Pollini T, et al. “Mickey Mouse sign” to identify and remove cystic duct stones in postcholecystectomy syndrome[J]. J Gastrointest Surg, 2024, 28(3): 334-335.DOI: 10.1016/j.gassur.2023.12.013.
[10]	Kaneko J, Takinami M, Tsuji A, et al. Endoscopic cystic duct remnant stone removal using peroral cholangioscopy[J]. Endoscopy, 2023, 55(S 01): E251-E252.DOI: 10.1055/a-1966-0351.
[11]	Popescu RC, Leopa N, Dumitru A, et al. Residual gallbladder and cystic duct stump stone after cholecystectomy: laparoscopic management[J]. Chirurgia, 2021, 116(4): 484-491.DOI: 10.21614/chirurgia.116.4.484.
[12]	储修峰, 吴志明, 孟兴成, 等. 腹腔镜胆囊管残端部分开放联合胆道造影在胆囊管结石治疗中的应用[J]. 中国微创外科杂志, 2013, 13(10): 877-878, 886.DOI: 10.3969/j.issn.1009-6604.2013.10.004.
[13]	Hao JY, Zhang YP, Huang XJ. Design and development of a disposable superfine catheter for visual examination of bile ducts and related animal experiments[J]. Front Surg, 2022, 9: 877040.DOI: 10.3389/fsurg.2022.877040.
[14]	宋兴超, 韩亚民, 杨伟斌, 等. 腹腔镜联合超细胆道镜治疗胆囊结石并无胆总管扩张胆总管结石的临床疗效[J]. 中国普通外科杂志, 2023, 32(12): 1965-1970.DOI: 10.7659/j.issn.1005-6947.2023.12.017.
[15]	Garg S, Dutta U, Chaluvashetty SB, et al. The anatomy of the cystic duct and its association with cholelithiasis: MR cholangiopancreatographic study[J]. Clin Anat, 2022, 35(7): 847-854.DOI: 10.1002/ca.23856.
[16]	张志, 屠政斌, 陈俊杰, 等. 胆道探条逐级扩张术联合支撑引导技巧在腹腔镜经胆囊管胆总管探查取石术中的应用[J]. 中华肝胆外科杂志, 2024, 30(2): 137-139.DOI: 10.3760/cma.j.cn113884-20230908-00065.
[17]	Nitta T, Chino Y, Kataoka J, et al. Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type Ⅲ Mirizzi syndrome[J]. Asian J Endosc Surg, 2019, 12(2): 227-231.DOI: 10.1111/ases.12602.
[18]	Huang Y, Peng F, Zhou B, et al. MRCP and microincision of the cystic duct can prevent residual gallstones: a single-center experience[J]. Asian J Surg, 2023, 46(12): 5721-5722.DOI: 10.1016/j.asjsur.2023.08.106.
[19]	鲁俊, 姜友, 刘家阳, 等. 胆囊管汇入部微切开行腹腔镜下胆总管探查术治疗细径胆总管结石的疗效分析[J]. 中华肝胆外科杂志, 2024, 30(4): 271-275.DOI: 10.3760/cma.j.cn113884-20231201-00150.
[20]	Brewer JO, Navaratne L, Marchington SW, et al. Porcine Aorto-Renal Artery (PARA) model for laparoscopic transcystic common bile duct exploration: the evolution of a training model to meet new clinical needs[J]. Langenbecks Arch Surg, 2021, 406(4): 1149-1154.DOI: 10.1007/s00423-020-02045-0.
[21]	冯其柱, 王思雨, 袁文康, 等. 腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(1): 68-72.DOI: 10.3877/cma.j.issn.2095-3232.2023.01.013.
[22]	刘进衡, 王妍亭, 廖芮, 等. 腹腔镜下胆囊管切开留置鼻胆管引流治疗正常直径胆总管结石的临床研究[J]. 肝胆胰外科杂志, 2024, 36(6): 369-373.DOI: 10.11952/j.issn.1007-1954.2024.06.009.
[23]	金浩, 刘会春, 李宗狂, 等. 超细胆道镜在经皮经肝途径胆管肿瘤活检中的应用[J]. 中国微创外科杂志, 2017, 17(8): 698-700.DOI: 10.3969/j.issn.1009-6604.2017.08.007.
[24]	冯其柱, 卢曼曼, 赵沨, 等. 以甲状腺乳头状癌为例探讨DIP付费方式对医疗费用和临床路径的影响[J]. 中国卫生统计, 2023, 40(4): 546-548.DOI: 10.11783/j.issn.1002-3674.2023.04.014.
[25]	刘静, 吕曼辰, 周苑, 等. 基于倾向性匹配法的胆囊结石合并慢性胆囊炎手术DRG控费效果研究[J]. 安徽医学, 2023, 44(11): 1374-1378.DOI: 10.3969/j.issn.1000-0399.2023.11.020.

Please choose a citation manager

Content to export