Application of biliary stent placement under choledochoscope for gallstone with choledocholithiasis and acute cholangitis

doi:10.3877/cma.j.issn.1674-0793.2023.02.005

Abstract

Abstract:

Objective

To compare the difference between modified biliary stent placement in laparoscopic common bile duct exploration (LCBDE) and primary suture and endoscopic retrograde cholangiopancreatography (ERCP)+laparoscopic cholecystectomy (LC) for gallstone with choledocholithiasis and acute cholangitis.

Methods

From June 2021 to July 2022, the clinical data of 66 patients with gallstone, choledocholithiasis and acute cholangitis were retrospectively analyzed. Among them, 33 cases were treated with LCBDE and primary suture with modified biliary stent (LCBDE group), and 33 cases with ERCP+LC (ERCP group).

Results

There was no statistically significant difference between the two groups in the change trend of postoperative inflammatory indexes within 3 days after surgery. The incidence of postoperative pancreatitis in LCBDE group was lower than that in ERCP group (P=0.009), and the total cost of hospitalization was lower (t=38.970, P=0.008). Following up for 6 months, there was 1 case of bile leakage, 1 case of biliary tract infection and 1 case of incision infection in the LCBDE group, with no statistically significant difference in the total complication rate with ERCP group (9.09% vs 9.09%, P=0.500).

Conclusion

The application of modified biliary stent placement in LCBDE and primary suture is safe and effective for patients with choledocholithiasis and acute cholangitis.

Key words: Acute cholangitis, Choledochal exploration, Primary suture, Biliary stent, Endoscopic retrograde cholangiopancreatography, Laparoscopes, Cholecystectomy

Hao Chen, Liang Lin, Keqiang Ma, Jianbin Huang, Xubin Qiu, Tiansheng Cao. Application of biliary stent placement under choledochoscope for gallstone with choledocholithiasis and acute cholangitis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 110-114.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2023.02.005

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References 12

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组别	LCBDE组	ERCP组	统计值	P值
例数	33	33
性别			0.243	0.622
男	16(48.48)	18(54.55)	0.154	0.132
女	17(51.52)	15(45.45)	0.176	0.098
年龄(岁)^a	53.27±8.06	49.30±7.05	0.235	1.021
白细胞计数(×10⁹/L)^a
术前	7.82±1.05	10.77±1.34	0.012	0.986
术后3 d	7.83±1.03	9.83±1.21	0.321	0.635
C反应蛋白(mg/L)^a
术前	15.22±1.89	17.17±2.01	0.123	0.874
术后3 d	33.72±3.12	33.39±5.31	0.456	0.352
降钙素原(μg/L)^a
术前	2.34±0.15	0.12±0.01	0.056	0.098
术后3 d	1.02±0.02	1.20±0.03	0.253	1.650
丙氨酸转氨酶(U/L)^a
术前	284.70±50.12	35.91±5.20	1.324	0.051
术后3 d	93.75±10.23	108.94±11.23	0.698	0.210
γ-谷氨酰转肽酶(U/L)^a
术前	422.97±89.03	320.54±56.21	2.698	0.064
术后3 d	222.85±12.31	181.70.81±13.12	0.985	0.098
总胆红素(μmol/L)^a
术前	86.7±3.42	47.84±5.15	1.874	0.078
术后3 d	31.01±5.31	30.12±5.23	0.321	1.256
淀粉酶(U/L)^a
术前	144.38±8.56	564.03±101.10	3.685	0.053
术后3 d	87.91±15.63	94.11±18.53	1.365	0.035
合并疾病
高血压	8(24.24)	7(21.21)	0.986	0.875
心脑血管病	5(15.15)	2(6.06)	0.236	0.062
糖尿病	0(0)	1(3.03)	0.025	0.058
ASA分级
Ⅰ	10(30.30)	11(33.33)	0.984	0.867
Ⅱ	14(42.42)	21(63.64)	0.754	0.587
Ⅲ	9(27.27)	0(0)	1.265	0.012^b
Ⅳ	0(0)	1(3.03)	0.635	0.514
结石直径(cm)	1.40±0.12	0.66±0.03	0.521	0.060
结石数量(个)	1.96±0.65	1.30±0.08	0.765	0.124
结石嵌顿	3(9.09)	1(3.03)	0.241	0.071

组别	LCBDE组	ERCP组	统计值	P值
例数	33	33
性别			0.243	0.622
男	16(48.48)	18(54.55)	0.154	0.132
女	17(51.52)	15(45.45)	0.176	0.098
年龄(岁)^a	53.27±8.06	49.30±7.05	0.235	1.021
白细胞计数(×10⁹/L)^a
术前	7.82±1.05	10.77±1.34	0.012	0.986
术后3 d	7.83±1.03	9.83±1.21	0.321	0.635
C反应蛋白(mg/L)^a
术前	15.22±1.89	17.17±2.01	0.123	0.874
术后3 d	33.72±3.12	33.39±5.31	0.456	0.352
降钙素原(μg/L)^a
术前	2.34±0.15	0.12±0.01	0.056	0.098
术后3 d	1.02±0.02	1.20±0.03	0.253	1.650
丙氨酸转氨酶(U/L)^a
术前	284.70±50.12	35.91±5.20	1.324	0.051
术后3 d	93.75±10.23	108.94±11.23	0.698	0.210
γ-谷氨酰转肽酶(U/L)^a
术前	422.97±89.03	320.54±56.21	2.698	0.064
术后3 d	222.85±12.31	181.70.81±13.12	0.985	0.098
总胆红素(μmol/L)^a
术前	86.7±3.42	47.84±5.15	1.874	0.078
术后3 d	31.01±5.31	30.12±5.23	0.321	1.256
淀粉酶(U/L)^a
术前	144.38±8.56	564.03±101.10	3.685	0.053
术后3 d	87.91±15.63	94.11±18.53	1.365	0.035
合并疾病
高血压	8(24.24)	7(21.21)	0.986	0.875
心脑血管病	5(15.15)	2(6.06)	0.236	0.062
糖尿病	0(0)	1(3.03)	0.025	0.058
ASA分级
Ⅰ	10(30.30)	11(33.33)	0.984	0.867
Ⅱ	14(42.42)	21(63.64)	0.754	0.587
Ⅲ	9(27.27)	0(0)	1.265	0.012^b
Ⅳ	0(0)	1(3.03)	0.635	0.514
结石直径(cm)	1.40±0.12	0.66±0.03	0.521	0.060
结石数量(个)	1.96±0.65	1.30±0.08	0.765	0.124
结石嵌顿	3(9.09)	1(3.03)	0.241	0.071

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