Three modalities on common bile duct exploration
| Autor: | Cheng-Lin Qin, Ren-Gen Fan, Xu-Dong Wu, Jing Jia, Wen-Zhang Zha, Yong-Hua Xu, Yong Zhou, Biao Zhang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Hepatic Duct Common 03 medical and health sciences 0302 clinical medicine medicine Humans Common Bile Duct Common bile duct exploration Common bile duct Bile duct business.industry Gastroenterology Gallstones Length of Stay medicine.disease Surgery medicine.anatomical_structure Choledocholithiasis 030220 oncology & carcinogenesis Choledochostomy Cholecystitis Cystic duct Drainage 030211 gastroenterology & hepatology Laparoscopy Bile Ducts Complication business Left Hepatic Duct |
| Zdroj: | Zeitschrift fur Gastroenterologie. 55(9) |
| ISSN: | 1439-7803 |
| Popis: | Background Choledocholithiasis can be managed by transcystic (TC) and transduct (TD) stone extraction or using cholangioscopy through the left hepatic duct orifice (LHD). Objective The aim of this study is to evaluate the safety and effectiveness of common bile duct exploration through the TC approach, TD approach, and LHD approach for choledocholithiasis, with a specific emphasis on the TC and LHD approaches versus the TD approach. Methods Between January 2011 and June 2014, a total of 172 choledocholithiasis patients accompanied by cholecystitis and/or left intrahepatic gallstones were scheduled for laparoscopic or open common bile duct (CBD) exploration using cholangioscopy through the CBD (TD group: n = 72), cystic duct (TC group: n = 63), or LHD orifice (LHD group: n = 37). T-tube insertion was performed in selected patients. Patients were regularly followed up at bimonthly intervals or more frequently in presence of any symptom. Primary outcomes measures included overall operative time, length of hospital stay, and postoperative bile leaks. Results Successful bile duct clearance was 100 % in the TD group, 93.6 % in the TC group, and 90.9 % in the LHD group. Sixteen cases in the TD group had T-tube placement in contrast to no cases in the TC and LHD groups. There were more bile leaks after TD stone extraction (12.5 %) than TC (3.2 %) and LHD stone extraction (0 %), which prolonged hospitalization in the TD group more than in the TC and LHD groups. For choledocholithiasis patients accompanied by cholecystitis, 2 groups (TC and TD groups) were comparable in operative time. However, for choledocholithiasis patients accompanied by left intrahepatic gallstones, the LHD group had a significantly shorter operative time than the TD group (121.1 ± 16.9 minutes vs. 149.3 ± 42.8 minutes, p Conclusion The TD group had a higher stone clearance rate but was associated with a higher risk of bile leaks. TC and LHD stone extraction, which seems to be the more effective approach with lower complication rates, is an accessible technique that simplifies the operation procedure by avoiding choledochotomy and subsequent T-tube insertion. |
| Databáze: | OpenAIRE |
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