Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGShu-jin , LINing , LIbei , HUhai-jie ,  CHENLi-ping

Department of Bile Duct Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

CHENLi-ping, Email: 47137417@qq.com

Keywords：

Cholecystolithiasis; Choledocholithiasis; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Elderly patient

DOI：

10.7507/1007-9424.20160369

Video：

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Objective To compare the effect of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients and non-elderly patients. Methods The clinical data of 185 cases of cholecystolithiasis combined with choledocholithiasis who treated in our hospital from September 2010 to November 2015 were analyzed retrospectively. Then the 185 cases of holecystolithiasis combined with choledocholithiasis were divided into elderly patients group (n=74) and the non-elderly patients group (n=111). The operative time, intraoperative blood loss, postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, incidence of complications, unplanned analgesia, stone-free rate, rate of conversion to laparotomy, recurrence of stone, and mortality were compared between the two groups. Results ① Intraoperative and postoperative indexes. No significant difference was noted in operative time and intraoperative blood loss (P > 0.050), but the postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, and ratio of indwelling T tube of elderly patients group were all higher or longer than corresponding index of non-elderly patients group (P < 0.050). ② Postoperative complications and unplanned analgesia. There was no striking discrepancy in incidence of complications (including biliary leakage, peritonitis, haemorrhage, vomit, ectoralgia, and fever), and Clavien-Dindo grade (P > 0.050), except unplanned analgesia (P=0.007), the rate of unplanned analgesia in elderly patients group was higher than that of non-elderly patients group. ③Surgical effect. There was no significant difference in the stone-free rate, rate of conversion to laparotomy, and rate of recurrence of stone between the 2 groups (P > 0.050). Conclusion LC+LCBDE is also safe and effective in treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients, it's worthy to be expanded and be used broadly.

Citation： WANGShu-jin, LINing, LIbei, HUhai-jie, CHENLi-ping. Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1455-1459. doi: 10.7507/1007-9424.20160369 Copy

1.	Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients:as a first treatment strategy for common bile duct stones. J Korean Surg Soc, 2011, 81(2):128-133.
2.	范彥, 吳杰, 黃曉東, 等.老年膽總管結石內鏡下治療特殊性的臨床分析.中華肝膽外科雜志, 2011, 17(9):781-783.
3.	陳盛, 鄭江華, 區應亮, 等.兩種微創方式治療膽囊結石合并膽總管結石的臨床療效比較.中國普外基礎與臨床雜志, 2012, 19(11):1213-1217.
4.	Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term term results of laparoscopic common bile duct exploration. Surg Endosc, 2003, 17(1):19-22.
5.	Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystec-tomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial. Surg Endosc, 2014, 28(3):875-885.
6.	Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single center. Ann Surg Treat Res, 2014, 86(1):1-6.
7.	顧大男.老年人年齡界定和重新界定的思考.中國人口科學, 2000, (3):42-51.
8.	Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures:analysis of 2010 to 2012. J Urol, 2013, 190(4):1271-1274.
9.	Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
10.	石景森, 王炳煌.膽道外科基礎與臨床.北京:人民衛生出版社, 2003:497.
11.	張煜.肝膽管結石的外科治療.中外醫療, 2011, 30(30):90.
12.	李相哲.普外科肝膽結石病46例患者的臨床分析.中國醫藥指南, 2013, 11(26):464-467.
13.	趙冬雨, 成麗婭, 于健.膽囊結石繼發膽總管結石不同手術方式的臨床療效分析.中國普外基礎與臨床雜志, 2014, 21(4):498-500.
14.	Costi R, Gnocchi A, Di Mario F, et al. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol, 2014, 20(37):13382-13401.
15.	張樂, 白月奎, 歐云菘, 等.腹腔鏡膽囊切除膽道探查術治療膽囊結石合并膽總管結石的臨床觀察.中國普通外科雜志, 2014, 23(8):1141-1143.
16.	Kim SB, Kim KH, Kim TN. Comparison of outcomes and complications of endoscopic common bile duct stone removal between asymptomatic and symptomatic patients. Dig Dis Sci, 2016, 61(4):1172-1177.
17.	王中魁, 趙海鷹, 劉金鋼, 等.老年人膽囊結石合并膽總管結石術式選擇探討(附60例報告).中國實用外科雜志, 2015, 27(4):448-450.
18.	吳文廣, 王雪峰. ERCP相關胰腺及十二指腸損傷特點及外科治療.中國實用外科雜志, 2015, 35(3):327-329.
19.	李宇, 郝杰, 孫昊, 等.一期腹腔鏡膽囊切除聯合膽總管探查取石與分期內鏡取石和腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的比較.中國普通外科雜志, 2016, 25(2):202-208.
20.	Cuschieri A, Lezoche E, Mornino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc, 1999, 13(10):952-957.
21.	Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancrea-tography plus laparoscopic cholecystectomy for choledocholithiasis:a prospective randomized study. Am J Surg, 2013, 206(4):457-463.
22.	菅志遠, 沈先鋒, 黃林生, 等.三種微創方式治療膽囊結石合并膽總管結石的臨床療效分析.中國普通外科雜志, 2015, 24(2):275-279.
23.	趙冬雨, 成麗婭, 沈宏, 等.腹腔鏡聯合膽道鏡治療膽囊結石合并膽總管結石的臨床應用研究.中國普外基礎與臨床雜志, 2013, 20(7):793-796.
24.	Kenny R, Richardson J, McGlone ER, et al. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy:is there any difference. Int J Surg, 2014, 12(9):989-993.
25.	孫學軍, 盧樂, 石景森.肝膽管結石的微創外科治療進展.中國普外基礎與臨床雜志, 2006, 13(4):403-405.
26.	Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
27.	鐘偉, 倪謝根.腹腔鏡聯合纖維膽道鏡與開腹手術治療老年膽總管結石對術后疼痛及胃腸功能的影響.中國普通外科雜志, 2015, 24(2):280-283.

1. Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients:as a first treatment strategy for common bile duct stones. J Korean Surg Soc, 2011, 81(2):128-133.
2. 范彥, 吳杰, 黃曉東, 等.老年膽總管結石內鏡下治療特殊性的臨床分析.中華肝膽外科雜志, 2011, 17(9):781-783.
3. 陳盛, 鄭江華, 區應亮, 等.兩種微創方式治療膽囊結石合并膽總管結石的臨床療效比較.中國普外基礎與臨床雜志, 2012, 19(11):1213-1217.
4. Riciardi R, Islam S, Canete JJ, et al. Effectiveness and long-term term results of laparoscopic common bile duct exploration. Surg Endosc, 2003, 17(1):19-22.
5. Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystec-tomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial. Surg Endosc, 2014, 28(3):875-885.
6. Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single center. Ann Surg Treat Res, 2014, 86(1):1-6.
7. 顧大男.老年人年齡界定和重新界定的思考.中國人口科學, 2000, (3):42-51.
8. Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures:analysis of 2010 to 2012. J Urol, 2013, 190(4):1271-1274.
9. Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
10. 石景森, 王炳煌.膽道外科基礎與臨床.北京:人民衛生出版社, 2003:497.
11. 張煜.肝膽管結石的外科治療.中外醫療, 2011, 30(30):90.
12. 李相哲.普外科肝膽結石病46例患者的臨床分析.中國醫藥指南, 2013, 11(26):464-467.
13. 趙冬雨, 成麗婭, 于健.膽囊結石繼發膽總管結石不同手術方式的臨床療效分析.中國普外基礎與臨床雜志, 2014, 21(4):498-500.
14. Costi R, Gnocchi A, Di Mario F, et al. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol, 2014, 20(37):13382-13401.
15. 張樂, 白月奎, 歐云菘, 等.腹腔鏡膽囊切除膽道探查術治療膽囊結石合并膽總管結石的臨床觀察.中國普通外科雜志, 2014, 23(8):1141-1143.
16. Kim SB, Kim KH, Kim TN. Comparison of outcomes and complications of endoscopic common bile duct stone removal between asymptomatic and symptomatic patients. Dig Dis Sci, 2016, 61(4):1172-1177.
17. 王中魁, 趙海鷹, 劉金鋼, 等.老年人膽囊結石合并膽總管結石術式選擇探討(附60例報告).中國實用外科雜志, 2015, 27(4):448-450.
18. 吳文廣, 王雪峰. ERCP相關胰腺及十二指腸損傷特點及外科治療.中國實用外科雜志, 2015, 35(3):327-329.
19. 李宇, 郝杰, 孫昊, 等.一期腹腔鏡膽囊切除聯合膽總管探查取石與分期內鏡取石和腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的比較.中國普通外科雜志, 2016, 25(2):202-208.
20. Cuschieri A, Lezoche E, Mornino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc, 1999, 13(10):952-957.
21. Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancrea-tography plus laparoscopic cholecystectomy for choledocholithiasis:a prospective randomized study. Am J Surg, 2013, 206(4):457-463.
22. 菅志遠, 沈先鋒, 黃林生, 等.三種微創方式治療膽囊結石合并膽總管結石的臨床療效分析.中國普通外科雜志, 2015, 24(2):275-279.
23. 趙冬雨, 成麗婭, 沈宏, 等.腹腔鏡聯合膽道鏡治療膽囊結石合并膽總管結石的臨床應用研究.中國普外基礎與臨床雜志, 2013, 20(7):793-796.
24. Kenny R, Richardson J, McGlone ER, et al. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy:is there any difference. Int J Surg, 2014, 12(9):989-993.
25. 孫學軍, 盧樂, 石景森.肝膽管結石的微創外科治療進展.中國普外基礎與臨床雜志, 2006, 13(4):403-405.
26. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
27. 鐘偉, 倪謝根.腹腔鏡聯合纖維膽道鏡與開腹手術治療老年膽總管結石對術后疼痛及胃腸功能的影響.中國普通外科雜志, 2015, 24(2):280-283.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Effect of Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration Between Elderly and Non-Elderly Patients with Cholecystolithiasis and Choledocholithiasis

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