腹腔镜联合胆道镜一期手术与十二指肠镜联合腹腔镜分期手术治疗细径胆总管结石合并胆囊结石的疗效比较

目的:比较腹腔镜和胆道镜双镜联合一期手术与经典的十二指肠镜和腹腔镜分期手术治疗细径胆总管结石合并胆囊结石的临床疗效。方法:回顾性队列研究。纳入2016年4月—2020年8月天津市第五中心医院肝胆外科收治的细径胆总管（直径≤0.8 cm）结石合并胆囊结石患者121例，其中男80例、女41例，年龄18~84岁。根据治疗方法...

Comparison of the efficacy of LC+LCBDE one-stage surgical procedure and ERCP+LC two-stage surgical procedure in the treatment of small diameter choledocholithiasis combined with gallbladder stones

Objective This study aimed to investigate the surgical protocol of combined laparoscopic and cholangioscopic double-scope one-stage procedure of small diameter choledocholithiasis combined with gallbladder stones and the classical duodenoscopic and laparoscopic two-stage procedure and to compare the clinical efficacy of the two different surgical treatments. Methods A retrospective analysis was conducted on 121 patients (80 males and 41 females; 18-84 years old) with small diameter common bile duct (diameter ≤0.8 cm) stones combined with gallbladder stones who were admitted to Tianjin No. 5 Central Hospital from April 2016 to August 2020. The patients were divided into two groups according to the different treatment methods. The first group (59 patients) was treated with the combined method of duodenoscopic extraction of common bile duct stones and laparoscopic cholecystectomy (i.e., ERCP+LC), whereas the second group (62 patients) was treated with laparoscopic cholecystectomy + intraoperative choledochoscopy via cystic duct route lithotripsy (i.e., LC+LCBDE). The length of hospital stay, liver function indexes, and complications were compared between the two groups. Results No statistically significant differences were found in the gender composition ratio, age, and the diameter of the common bile duct and the number of stones between the two groups (all P values > 0.05). The mean length of stay in the LC+LCBDE group ([9.32 ± 5.20] days) was lower than that in the ERCP+LC group ([13.35 ± 8.67] days), and the difference was statistically significant (t=3.12,P = 0.002). The ALT ([36.5±15.2] U/L) at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group ([73.1±53.7] U/L), and the AST ([36.3±11.2] U/L) at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group ([55.5±40.3] U/L); the difference was statistically significant (t=5.16, t=3.61, all P values <0.001). No significant difference was found between the TBIL and DBIL (t=0.85, t=1.29, all P values >0.05) of the two groups at 1 day before discharge. Two patients (3.3%) in the ERCP+LC group had elevated amylase levels and one patient (1.6%) in the LC+LCBDE group had biliary leakage after operation. No statistically significant difference was found in the occurrence of complications between the two groups (χ²=0.63, P=0.529). Conclusion Compared with the ERCP+LC treatment, the LC+LCBDE treatment for small diameter common bile duct stones has advantages of shorter hospital stay and faster recovery of liver function. The LC+LCBDE treatment avoids the incision of the papillary sphincter. This treatment is safe and effective and has better clinical outcomes. It should be further promoted and applied.