Extrahepatic Bile Duct Stones Research Articles

Safety, efficacy, and feasibility of percutaneous transhepatic endoscopic holmium laser lithotripsy for bile duct stones.

To evaluate the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy (PTEHL) for patients with intrahepatic bile duct (IHBD) and common bile duct (CBD) stones. This retrospective study included 530 patients (mean age: 55.6 ± 8.5; 64.2% female) with IHBD and/or CBD stones at a single institution from January 2019 to December 2021. PTEHL was the chosen treatment for patients with large, complex stones, or those for whom Endoscopic Retrograde Cholangiopancreatography (ERCP) failed or presented difficulties. Patients showing signs of cholangitis required pre-PTEHL drainage. Stone clearance was confirmed by post-procedural cholangiography, and the technique was deemed successful when target stones were removed. Complications were recorded according to the Society of Interventional Radiology adverse event classification. The mean stone size was 20.9 ± 11.9 mm, multiple stones observed in 460 patients (86.8%). A total of 225 patients (42.5%) had stones in both the IHBD and CBD; biliary-enteric anastomosis in 50 patients (9.4%). ERCP for stone removal proved unsuccessful in 18 patients (3.4%). Pre-IHBD drainage was performed in 271 patients (51.1%). The majority (488 patients, 92.1%) underwent a single PTEHL session. The technique was successful in 523 patients (98.7%), with 7 patients requiring surgery due to unsuccessful target stone removal. Complications were noted in 75 patients (14.2%), including 4.7% with severe complications and 9.4% with minor complications. PTEHL is a safe and effective method for the treatment of both intrahepatic and extrahepatic bile duct stones. This approach is a valuable option for complex stone cases, particularly when ERCP is unsuccessful or encounters significant challenges. Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy is a safe and effective treatment method for intrahepatic and extrahepatic biliary stones, particularly in cases of complex stones. Percutaneous transhepatic biliary stone removal is difficult for large or intraductal stones. Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy (PTEHL) demonstrated a high success rate with few major complications. PTEHL can treat biliary stones, particularly stones that are difficult or have failed ERCP treatment.

Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones

ObjectiveTo compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. MethodsFrom September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. ResultsIn the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7 % vs. 95.3 %) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7 %) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 h after operation was significantly lower than that in the LCBDE group (3.9 ± 1.6 vs 6.5 ± 2.4). There were no significant differences in biliary leakage (1.7 % vs. 4.7 %), postoperative cholangitis (5.0 % vs. 5.8 %), incision infection (3.3 % vs. 3.5 %), and bile duct stone residue rate (5.0 % vs 3.5 %) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1 ± 2.3d vs 7.9 ± 3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9 ± 8549.5 vs 34635.9 ± 5893.7 yuan). ConclusionERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.

Enfermedades inflamatorias de páncreas y vía biliar

Inflammatory involvement of the bile duct and pancreas can present in different ways depending on the etiology and place of involvement. These are rare diseases; the most common is autoimmune pancreatitis, which has two subtypes: type 1, which is considered the pancreatic manifestation of systemic IgG4-related disease (IgG4-RD) and type 2, which is considered a primarily pancreatic disease. The most common clinical presentation is in the form of jaundice and pancreatic masses with or without abdominal pain, which necessitates a differential diagnosis with pancreatic adenocarcinoma. Treatment is based on corticosteroids, with good response rates, but there is a non-negligible risk of recurrence which sometimes requires treatment with anti-CD20 (rituximab) or immunosuppressants. IgG4-RD can also affect the bile duct, in which case it is called IgG4-related sclerosing cholangitis, and treatment is similarly based on corticosteroids. Lastly, recurrent pyogenic cholangitis is a rare type of inflammatory disease of the bile duct characterized by the formation of recurrent intrahepatic and extrahepatic bile duct stones and recurrent episodes of cholangitis that often require endoscopic, radiological, or surgical treatment in addition to medical treatment.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra- and extrahepatic bile duct stones.

Bile duct stones (BDSs) may cause patients to develop liver cirrhosis or even liver cancer. Currently, the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory, and there is a risk of postoperative complications. To compare the clinical effects of dual-modality endoscopy (duodenoscopy and laparoscopy) with those of traditional laparotomy in the treatment of intra- and extrahepatic BDSs. Ninety-five patients with intra- and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected; 45 patients in the control group were treated by traditional laparotomy, and 50 patients in the research group were treated by dual-modality endoscopy. The following factors were collected for analysis: curative effects, safety (incision infection, biliary fistula, lung infection, hemobilia), surgical factors [surgery time, intraoperative blood loss (IBL) volume, gastrointestinal function recovery time, and length of hospital stay], serum inflammatory markers [tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8], and oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced protein oxidation products (AOPPs)]. The analysis revealed markedly better efficacy (an obviously higher total effective rate) in the research group than in the control group. In addition, an evidently lower postoperative complication rate, shorter surgical duration, gastrointestinal function recovery time and hospital stay, and lower IBL volume were observed in the research group. Furthermore, the posttreatment serum inflammatory marker (TNF-α, IL-6, and IL-8) levels were significantly lower in the research group than in the control group. Compared with those in the control group, the posttreatment GSH-Px, SOD, MDA and AOPPs in the research group were equivalent to the pretreatment levels; for example, the GSH-Px and SOD levels were significantly higher, while the MDA and AOPP levels were lower. Dual-modality endoscopy therapy (duodenoscopy and laparoscopy) is more effective than traditional laparotomy in the treatment of intra- and extrahepatic BDSs and has a lower risk of postoperative complications; significantly shortened surgical time; shorter gastrointestinal function recovery time; shorter hospital stay; and lower intraoperative bleeding volume, while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Nursing Effect of Rapid Rehabilitation Surgery Concept in Laparoscopic Surgery for Extrahepatic Bile Duct Stones

Nursing Effect of Rapid Rehabilitation Surgery Concept in Laparoscopic Surgery for Extrahepatic Bile Duct Stones

Factors influencing recurrence and model development for recurrence of minimally invasive percutaneous transhepatic lithotripsy: a single-center retrospective study.

To identify factors influencing recurrence after percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) and to develop a predictive model. We retrospectively analyzed clinical data from 354 patients with intrahepatic and extrahepatic bile duct stones treated with PTCSL at Qinzhou First People's Hospital between February 2018 and January 2020. Patients were followed for three years and categorized into non-recurrence and recurrence groups based on postoperative outcome. Univariate analysis identified possible predictors of stone recurrence. Data were split using the gradient boosting machine (GBM) algorithm, assigning 70% as the training set and 30% as the test set. The predictive performance of the GBM model was assessed using the receiver operating characteristic (ROC) curve and calibration curve, and compared with a logistic regression model. Six factors were identified as significant predictors of recurrence: age, diabetes, total bilirubin, biliary stricture, number of stones, and stone diameter. The GBM model, developed based on these factors, showed high predictive accuracy. The area under the ROC curve (AUC) was 0.763 (95% CI: 0.695-0.830) for the training set and 0.709 (95% CI: 0.596-0.822) for the test set. Optimal cutoff values were 0.286 and 0.264, with sensitivities of 62.30% and 66.70%, and specificities of 77.20% and 68.50%, respectively. Calibration curves indicated good agreement between predicted probabilities and observed recurrence rates in both sets. DeLong's test revealed no significant differences between the GBM and logistic regression models in predictive performance (training set: D = 0.003, P = 0.997 > 0.05; test set: D = 0.075, P = 0.940 > 0.05). Biliary stricture, stone diameter, diabetes, stone number, age, and total bilirubin significantly influence stone recurrence after PTCSL. The GBM model, based on these factors, demonstrates robust accuracy and discrimination. Both GBM and logistic regression models effectively predicted stone recurrence post-PTCSL.

Retracted: Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones

Retracted: Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones

Biliary Tract Exploration After Laparoscopic Left-sided Hepatectomy: A Comparative Study of Left Hepatic Duct Orifice Versus Common Bile Duct Approach.

Laparoscopic left-sided hepatectomy (LLH) and additional biliary tract exploration are effective methods to treat left-sided hepatolithiasis (LSH) combined with extrahepatic bile duct stones. Although biliary tract exploration through common bile duct (CBD) incision has been widely accepted, the safety and effectiveness of the left hepatic duct (LHD) orifice approach after LLH is still in debate. One hundred and forty-four patients with LSH who underwent LLH and biliary tract exploration in our institution from April 2014 to September 2021 were enrolled in the retrospectively study. They were divided into 3 groups: LHD group (n=67), CBD/T-tube group (n=58), and CBD/PC group (n=19). Patients' demographic characteristics, intraoperative, and postoperative outcomes were retrospectively analyzed. LHD group exhibited a shorter operative time (202.8±42.2 vs. 232.7±47.5min, P =0.000), time to first bowel movement (2.3±0.5 vs. 2.9±0.7d, P =0.000) and postoperative hospital stay (7.5±2.1 vs. 9.8±5.2d, P =0.001) compared with the CBD/T-tube group. The lithotomy time in the LHD group was significantly longer than that in the CBD/T-tube group (33.6±7.3 vs. 29.0±6.3min, P =0.000) and CBD/PC group (33.6±7.3 vs. 28.7±3.7, P =0.006). Intraoperative blood loss, blood transfusion rate, initial stone clearance rate, and stone recurrence rate all had no significant differences between the 3 groups (all P >0.05). LHD group showed less rate of electrolyte imbalance than that of the CBD/T-tube group (3.0% vs. 19.0%, P =0.004) but it was equivalent to the CBD/PC group ( P >0.05). The type of biliary tract exploration (odds ratio: 5.43, 95% confidence interval: 0.04-0.95, P =0.032) as independent predictors of electrolyte imbalance. No reoperation and mortality occurred in the 3 groups. The conversion rate was comparable among 3 groups (1.5% vs. 1.7% vs. 0, all P >0.05). No significant difference in stone recurrence rate was seen (1.5% vs. 3.4% vs. 0, all P >0.05). Biliary tract exploration through LHD orifice after LLH is a safe and effective treatment for selected patients with LSH, with an advantage over the T-tube drainage in the field of operative time, the incidence of electrolyte imbalance, recovery of gastrointestinal function, and postoperative hospital stay.

The safety and feasibility of laparoscopic approach for the management of intrahepatic and extrahepatic bile duct stones in patients with prior biliary tract surgical interventions

The purpose of this study was to compare the efficacy and safety of laparoscopic and open reoperation for intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures. The clinical data were retrospectively analyzed of intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures who underwent reoperation in the Second General Surgery Department of China Medical University from January 2012 to February 2018. 44 eligible cases were selected. In accordance with the surgical procedures, they were divided into a laparoscopy group (n = 23) and an open surgery group (n = 21). No statistically significant differences were found in the preoperative general clinical data between the two group. Two patients in the laparoscopy group were converted to open surgery. Comparisons between the two groups showed that the intraoperative blood loss [90.87 ± 62.95 (ml) vs. 152.38 ± 118.82 (ml)], the proportion of postoperative analgesia [10/23 (43.5%) vs. 16/21 (76.2%)], and the length of stay [7.19 ± 5.32 (d) vs. 11.00 ± 4.66 (d)] in the laparoscopy group were significantly lower than those in the open surgery group (P < 0.05). Laparoscopic biliary reoperation for intrahepatic and extrahepatic bile duct stones was feasible. Compared with open surgery, laparoscopic surgery has the advantages of less bleeding, a shorter postoperative length of stay, and a lower rate of additional postoperative analgesia.

Analysis of the Value of MR Cholangiopancreatography and Abdominal CT in the Diagnosis of Extrahepatic Bile Duct Stones

Analysis of the Value of MR Cholangiopancreatography and Abdominal CT in the Diagnosis of Extrahepatic Bile Duct Stones

Age, gender, geographic and clinical differences for gallstones in China: a nationwide study

BackgroundThe etiology of gallstones at different anatomical locations may be varied. However, it has not been well studied about the prevalence of gallstones by anatomical locations and their associated factors in China.MethodsWe used the data set from preventive health screening centers covering all provinces in mainland China except for Tibet, and a total of 10,937,993 adults were included, who received abdominal ultrasonography in 2017. We analyzed the prevalence of gallstones classified by anatomical locations, including gallbladder (GB) stones, intrahepatic bile duct (IHD) stones, and extrahepatic bile duct (EHD) stones. Further, their associated factors were investigated using a logistic regression model with body mass index (BMI), fasting glucose, total triglyceride, and previous cholecystectomy, with covariates of age and sex.ResultsThe age- and gender-standardized prevalence (AGS-prevalence) of gallstone diseases was 5.13% (95% CI: 5.11–5.14%). GB, IHD, and EHD stones accounted for 76.3%, 24.3%, and 0.2% of all gallstone cases (concomitant cases were present). GB, IHD, and EHD gallstones presented different patterns by the age, gender, geographic and metabolic factors. Overall, the age-standardized prevalence was higher in women than that in men (5.41% vs. 4.85%, P<0.001). The gender standardized prevalence of all gallstone subtypes apparently increased with age (P<0.001), especially for GB stones from 1.05% (age 18–30) to 11.6% (age ≥70) (P<0.001). There was a marked geographic variation with AGS-prevalence ranging from 3.00% to 8.86% among different provinces. Noticeably, higher BMI, fasting glucose level, or total triglyceride level was associated with a higher prevalence of overall gallstones and GB stones (OR >1), but associated with a lower prevalence of IHD and EHD stones.ConclusionsThe prevalence of gallstones in China largely varied in its anatomical location, demographic factors, geographic location, and metabolic factors, suggesting that the etiology of each subtype may be different. Further investigation should be conducted.

Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones

Objective The researchers aim to assess how endoscopic retrograde cholangiopancreatography lithotomy and laparoscopic cholecystectomy affected pain and prognosis in individuals with gallstones and extrahepatic bile duct stones. Methods Researchers studied 100 persons with gallstones and extrahepatic bile duct stones from January 2016 to August 2021. They were split into two groups: control and observation. The control group underwent open cholecystectomy + choledocholithotomy + T-tube drainage. There were ERCP + lithotomy + Laparoscopic cholecystectomy procedures conducted on the observation group of patients (LC). The operation time, incision size, and bleeding volume; stone clearance rate and stone recurrence rate; visual analogue scale (VAS); Eating time, exhaust time, out of bed activity time, and postoperative hospital stay; the two groups' difficulties were contrasted and studied. Results The observation group's operation duration was much longer than the control group's, and the incision size and bleeding volume were significantly reduced in the observation group. When it came to recurrence, there was a significant difference between the observation group (2.0%) and the control group (4.0%), even though stone clearance did not differ substantially (20.00%). The VAS scores 3 and 7 days after surgery were significantly different between the observation and control groups. The observation group's eating time, exhaustion, activity time, and postoperative hospital stay were much shorter than the control group's; complications occurred at a lower rate (20%) in the observation group than in the control group (34%). Conclusion When gallstones and extrahepatic bile-duct stones are removed using laparoscopic lithotomy and laparoscopic cystoscopy (LC), the operation indices are improved and the risk of recurrence of stones is reduced and reducing the occurrence of complications, all of which improve patient outcomes and deserve to be considered a clinical reference.

Comparative study of the effect of U100 laser and pneumatic ballistic combined with percutaneous transhepatic cholangioscopic lithotomy in the treatment of intra-and extrahepatic bile duct stones and its effect on liver function.

Objectives:To compare the efficiency of U100 laser and pneumatic ballistics combined with percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in the treatment of intra-and extrahepatic bile duct stones and their effects on liver function.Methods:Medical records of 97 patients with intra-and extrahepatic bile duct stones treated in our hospital from May 2020 to May 2021 were selected for retrospective analysis. Of them, forty-three patients received pneumatic ballistic lithotripsy combined with PTCSL (Group-I), and 54 patients received U100 laser lithotripsy combined with PTCSL (Group-II). The therapeutic effects of the treatment in two groups and its effect on liver function were compared and analyzed.Results:There was no significant difference in the operation time and intraoperative bleeding (P>0.05) between the two groups. The postoperative pain duration and hospital stay of patients treated with U100 laser lithotripsy combined with PTCSL (Group-II) were shorter than those treated with pneumatic ballistic lithotripsy combined with PTCSL (Group-I), P<0.05. The biliary bleeding rate of patients in Group-II was lower (3.70%) than those in Group-I (16.27%, P<0.05), and the stone residue rate of patients in Group-II was also lower (1.85%) than those in Group-I (11.63%, P<0.05). The levels of total bilirubin (TBIL), alanine aminotransferase (ALT) and albumin (ALB) in Group-II patients were higher than in patients in Group-I.(P<0.05).Conclusion:Compared with pneumatic ballistics, U100 laser lithotripsy combined with PTCSL in the treatment of intra and extrahepatic bile duct stones has the advantages of less postoperative pain, shorter hospital stay, less biliary bleeding and stone residue, and less damage to liver function.

Application of CT Image Scanning Technology Based on Iris Algorithm in Clinical Diagnosis of Patients with Hepatobiliary Stones

Objective: To investigate the value of multi-slice spiral CT in the diagnosis of extrahepatic bile duct stones using Iris algorithm. Methods: 66 cases of extrahepatic bile duct stones underwent plain and enhanced multiline spiral CT. Observe the density, size, location and number of stones during the plain scan. According to the venous phase enhanced scan, the extrahepatic bile duct wall ≥2 mm was used as the thickening criterion to evaluate the stone density, size, number, and composition ratio of the site and its relationship with tube wall thickening. Results: A total of 57 cases of stones of different densities were found on CT. Nine cases of stones of equal density were not identified. Among the 56 cases with thickened wall, 87.50% (49/56) were concentric and 12.50% (7/56) were eccentric. The wall thickening occurred 62.50% (35/56) below the stone; 17.86% (10/56) was located on the level or above the stone, and 8.93% (5/56) was above the stone. 6 cases (6/56) (10.71%) showed extensive tube wall thickening, all caused by multiple stones. Conclusion: In the study of extrahepatic bile duct stones using the Iris algorithm, it was found that most concentric circular tube wall thickening occurred on or below the stone level. When plain CT scan does not show clear bile duct stones, and this phenomenon appears in the portal vein phase of enhanced scan, the possibility of stones should be considered.

Age, Gender, Geographic and Clinical Differences for Gallstone and Its Subtypes in China: A Nationwide Study Among Approximately 11 Million Adults

Background:There is no comprehensive nationwide study on the prevalence of gallstone and its risk factors in China. Methods:We used the data set from preventive health screening centers covering all provinces in mainland China except for Tibet, and a total of 10,937,993 adults were included, who received abdominal ultrasonography from January 1st to December 31st, 2017. Gallstone was categorized into gallbladder (GB) stones, intrahepatic bile duct (IHD) stones, and extrahepatic bile duct (EHD) stones. The prevalence of gallstone and its different subtypes, as well as their risk factors were investigated. Findings:The nationwide age-standardized and gender-standardized prevalence (ASGS-prevalence) of gallstone diseases in 2017 was 5.13% (95% CI: 5.11%-5.14%). GB stones accounted for 76.3% of all gallstone cases, followed by IHD (24.3%) and EHD (0.2%). The age standardized prevalence was higher in women than that in men (5.41% vs 4.85%, p 1). Interpretation:The gallstone disease was highly prevalent in China. The prevalence largely varied by disease subtype, demographic factors, geographic location and metabolic factors. Public health strategies preventing gallstones should be region-specific and target on the distinct risk factors of different gallstone subtypes. Funding Statement: This research was funded by International Science and Technology Cooperation Projects (2016YFE0107100 and 2015DFA30650), CAMS Clinical and Translational Medicine Research Funds (2019XK320006), CAMS Innovation Fund for Medical Science (CIFMS) (2017-I2M-4-003 and 2018-I2M-3-001), Capital Special Research Project for Health Development (2014-2-4012), Beijing Natural Science Foundation (L172055 and 7192158), the Fundamental Research Funds for the Central Universities (3332018032), the National Undergraduates Innovation and Training Program of Peking Union Medical College (2019zlgc0652), and National Ten-thousand Talent Program. Declaration of Interests: There is no conflict of interest to declare. Ethics Approval Statement: This study was reviewed and approved by the Institutional Review Board of Peking University (PU IRB).

Therapeutic Images of CT Image Analysis Based on 3D Visualization Technology in Patients with Hepatobiliary Stones

Objective: Paper for CT imaging in three-dimensional visualization technology for laparoscopy combined with biliary hard lens therapeutic clinical effect of extrahepatic bile duct stones were evaluated. Methods: Abdominal medical image 3D visualization software for our hospital CT imaging diagnosis and treatment of bile duct stones in 45 patients of bile duct stones three-dimensional visualization of clinical analysis and preoperative planning, and brought it into the operating room three-dimensional visualization model, guiding the implementation of the joint 3D laparoscopic biliary lithotripsy targeted hard lens. At the same time, as well as consistency with the actual hepatolithiasis distribution calculation operative 3D model visualization display; The operative time, bleeding, blood transfusion, stone clearance rate, morbidity and mortality perioperative after review stone recurrence rate was observed. Results: reproducing a three-dimensional patient model visualization liver, intrahepatic vascular anatomy of the liver bile duct stones distributed, real intraoperative and preoperative displayed three-dimensional visualization model consistent, pre-operative manner consistent with preoperative planning. Operation time (125.9±21.2) minutes, blood loss (38.8±8.5) ml, no massive hemorrhage and blood transfusion; MRCP examination by stone clearance rate was 100%; 2 biliary injury, bile leakage 1 complication the rate was 6.7%; There were no perioperative deaths. Stone recurrence two cases, the recurrence rate of 4.4%. Conclusion: The three-dimensional visualization techniques may be implemented hepatolithiasis accurate assessment of preoperative, intraoperative guidance of laparoscopic, endoscopic biliary hard gravel, stone liver resection operation, help to improve stone clearance rate, guarantee operation safety.

Treatment strategies of complicated extrahepatic bileduct stones

Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance, stricture removal, unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases, which include hepatic hilar bile duct stones incarceration, distal bile duct stone incarceration, Mirizzi syndrome, residual cystic duct stones, recurrent extrahepatic bile duct stones, and combined with portal hypertension or intrahepatic bile duct stones. Through comprehensive and meticulous preoperative evaluation, we can clarify the cause of extrahepatic bile duct stones, the location of stones and bile duct stenosis, the variability of bile duct, the anatomy of the hepatoduodenal ligament, the condition of liver function and biliary tract infection, and make the proper surgery plan. During the surgery, we apply the perihilar surgical techniques, pancreatic hilar plate reduction techniques, Oddi sphincter incision and shaping, and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate. It is important that reasonably select endoscopic retrograde cholangiopancreatography indications, correctly hold indications of bilioenteric anastomosis, and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones. Key words: Hepatolithiasis; Extrahepatic bileduct stone; Perihilar surgical techniques; Pancreatic hilar plate reduction techniques; Choledochoscope; Lithotripsy

Laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones

Objective To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones. Methods The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A T tube was used according to intraoperative conditions. Results Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation. Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved. Key words: Laparoscopy; Ultrasonography; Hepatectomy; Laparoscopic ultrasound; Precise surgery; Bile duct stone

Efficacy of laparoscopic choledochotomy and T tube drainage for the patients of extrahepatic bile duct stones

Objective To observe the effect and quality of life score of laparoscopic choledochotomy and T tube drainage for the patients of extrahepatic bile duct stones. Methods A total of 80 patients with calculus of extrahepatic bile duct in Shandong Provincial Third Hospital from February 2016 to April 2017 were retrospectively analyzed, including 41 males and 39 females, among which, 40 patients were treated with laparoscopic choledocholithotomy and T tube drainage(the study group), and the other 40 cases were operated on laparotomy(the control group) by hierarchical randomization grouping. After operation, the time of operation, the amount of bleeding during the operation, the time of postoperative exhaust, the time of postoperative hospitalization and the difference of adverse reactions were observed in the two groups. Follow-up at the end of 1st and 3th month, quality of life score was compared between the two groups. The measurement data with normal distribution were expressed as mean±standard deviation (Mean±SD), comparison between groups were performed using t test. The count data were expressed as rate(%), comparison between groups were performed using chi-square test. Results Comparison of data between the study group and the control group: operation time respectively were (97.23±10.21) min, (117.52±10.01) min, the amount of bleeding respectively were(87.73±10.54) ml, (185.13±11.56) ml, postoperative exhaust time respectively were (17.57±2.96) h, (38.44±3.06) h and the postoperative hospitalization time were (7.75±1.21) d, (12.03±3.85) d. The data of each group in the study group were lower than those in the control group, and the difference was statistically significant(P 0.05). Conclusions Compared with open surgery, laparoscopic choledocholithotomy with T tube drainage has significant clinical effect in the treatment of extrahepatic bile duct stones. It can improve the quality of life and safety, and it is suitable for clinical application. Key words: Laparoscopes; Common bile duct; Cholelithiasis; Quality of life score; T tube drainage

Primary closure after laparoscopic common bile duct exploration is feasible for elderly patients: 5-Year experience at a single institution

Laparoscopic common bile duct exploration (LCBDE) has been demonstrated safety and effective for patients with gallbladder stones and extrahepatic bile duct stones, however few studies reported its suitability for the treatment of elderly patients. Thus, our study aims to investigate the safety and feasibility of primary closure after LCBDE in the treatment of elderly patients. 408 out of 499 patients with Gallbladder stones complicated with choledocholithiasis who were undergone LCBDE and primary closure were divided into two groups: Group A (<65 years old, n=249) and Group B (≥65 years old, n=159) and the related clinical data were compared and analyzed by statistical method. Pre-operative American Society of Anesthesiologists (ASA) score of elderly patients was significantly higher than the younger patients (P<0.05). In both groups, the positive rate of Choledocholithiasis and bile sludge at exploration, number of stones in CBD, utilization rate of Electro-hydraulic lithotripsy, estimated blood loss, successful duct clearance, the rate of postoperative bile leakage, postoperative bile duct stricture, reoperation, stone recurrence, and other postoperative complications showed no significant difference (p>0.05). There were also no statistical differences between both groups in time to removal of drainage, postoperative hospital stay, readmission within 30 days and mortality (p>0.05). It is safe and feasible to treat the elderly patients with common bile duct stones under the premise of strict surgical indications, skilled laparoscopic procedures and accurate endoscopic suture techniques.