Tianjin Medical Journal

Tianjin Medical Journal ›› 2021, Vol. 49 ›› Issue (5): 505-508.doi: 10.11958/20203545

• Clinical Study • Previous Articles     Next Articles

Study on surgical treatment strategy for secondary choledocholithiasis

ZHANG Jing-hong1, SHANG Hai-tao2, LIU Jun-jian2, CHEN Shuai1, LI Zhong-lian2△   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of the Second Hepatobiliary and Pancreatic Surgery, Tianjin Nankai Hospital 
  • Received:2020-12-23 Revised:2021-02-23 Published:2021-05-15 Online:2021-05-25

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Abstract: Abstract: Objective　To explore the surgical treatment strategies for secondary choledocholithiasis, and to compare and analyze the advantages and disadvantages  of laparoscopic primary suture and endoscopic treatment. Methods　The clinical data of 188 patients with secondary common bile duct stones who underwent laparoscopic primary suture and endoscopic treatment were collected. All these patients were with gallbladder stones, 65 patients (primary suture group) underwent laparoscopic choledocholithotomy (LCBDE) and primary suture combined with cholecystectomy (LC), and 123 patients (endoscopic lithotomy group) who underwent endoscopic retrograde cholangiopancreatography (ERCP) combined with twelve papillary muscle incision and stone extraction (EST), and LC was performed in the second stage. The stone size, distribution, biliary tract infection, combined underlying diseases and length of hospitalization, postoperative complications, costs and other data were compared and analyzed between the two groups. Results　There were no significant differences in the diameter of the common bile duct, the number and the size of stones between the two groups. The length of hospitalization and hospitalization expenses were lower in the primary suture group than those in the endoscopic lithotomy group (P＜0.05). There were 2 cases of minor biliary fistula in the primary suture group and 21 cases of postoperative hyperamylase in the endoscopic lithotomy group. After 1 year follow-up, there was no biliary stricture or recurrence of stones in the two groups. Conclusion　Both treatment methods have merit and demerit, and under the condition of satisfying the indications, the primary suture of common bile duct for the treatment of secondary common bile duct stones has shorter hospital stay, lower cost and no damage to the normal physiological structure compared with the endoscopic lithotomy.

Key words: choledocholithiasis, suture techniques, abdomen, cholangiopancreatography, endoscopic retrograde, endoscopic sphincterotomy, primary closure