Experience of laparoscopic surgeries for choledocholithiasis after cholecystectomy

doi:10.3877/cma.j.issn.1674-0793.2026.01.004

Abstract

Abstract:

Objective

To investigate the safety and efficacy of laparoscopic surgeries for choledocholithiasis after cholecystectomy.

Methods

A retrospective analysis was performed on the clinical data of 26 patients who underwent laparoscopic surgeries for choledocholithiasis after cholecystectomy in Beijing Electric Power Hospital of State Grid Corporation from May 2018 to February 2025. According to the surgical methods, the patients were divided into laparoscopic common bile duct exploration group (LCBDE, 19 cases) and laparoscopic transcystic common bile duct exploration group (LTCBDE, 7 cases), and perioperative indicators were compared between the two groups. The impact of previous surgical methods on perioperative indicators was analyzed in subgroups.

Results

The length of residual cystic duct in the LTCBDE group was significantly longer than that in the LCBDE group [(1.7±0.7) cm vs (1.0±0.3) cm, P<0.05], and the postoperative hospital stay was significantly shorter than that in the LCBDE group [(8.1±2.3) d vs (15.3±3.4) d, P<0.05]. There were no statistically significant differences between the two groups in the interval from disease onset, the number and size of stones, preoperative blood tests, operation time, intraoperative blood loss, or postoperative complications. The previous surgical method was not related to the surgical time, intraoperative bleeding, or postoperative hospital stay. During the postoperative follow-up period of 3 to 83 months, no delayed biliary injuries or recurrence of common bile duct stones were observed.

Conclusions

Laparoscopic surgery is safe and feasible for patients with choledocholithiasis after cholecystectomy. LTCBDE has obvious advantages, and the laparoscopic surgical approach can be individually selected based on factors such as the length of the residual cystic duct.

Key words: Cholecystectomy, Choledocholithiasis, Laparoscopic surgery

Zhuo Liu, Zongming Zhang, Limin Liu, Chong Zhang, Yue Zhao, Hui Qi. Experience of laparoscopic surgeries for choledocholithiasis after cholecystectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(01): 18-23.

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Figures/Tables 6

References 38

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项目	LTCBDE组(7例)	LCBDE组(19例)	Z值	P值
结石数目（个）	1.00(1.0,2.0)	1.00(1.0,3.0)	59.000	0.634
结石大小（mm）	8.00(5.0,8.0)	10.00(6.0,10.0)	35.000	0.064
发病间隔时间（月）	60.00(24.0,72.0)	60.00(24.0,84.0)	64.500	0.907
WBC（×10⁹/L）	7.40(6.2,9.2)	6.50(5.0,12.2)	63.500	0.862
N%	78.90(70.2,92.6)	75.10(65.7,91.6)	57.500	0.603
CRP（mg/L）	33.02(4.0,86.4)	28.31(4.3,84.2)	61.000	0.751
TB（μml/L）	50.54(22.8,79.3)	56.83(14.4,107.0)	61.000	0.751
DB（μml/L）	31.76(7.1,48.8)	29.88(3.0,72.6)	63.000	0.840
ALT（U/L）	463.00(221.0,614.0)	165.00(37.0,314.0)	33.500	0.056
AST（U/L）	341.00(200.0,751.0)	152.00(31.0,207.0)	28.500	0.028
PCT（μg/L）	0.35(0.1,1.6)	1.73(0.1,6.3)	24.500	0.110

项目	LTCBDE组(7例)	LCBDE组(19例)	Z值	P值
结石数目（个）	1.00(1.0,2.0)	1.00(1.0,3.0)	59.000	0.634
结石大小（mm）	8.00(5.0,8.0)	10.00(6.0,10.0)	35.000	0.064
发病间隔时间（月）	60.00(24.0,72.0)	60.00(24.0,84.0)	64.500	0.907
WBC（×10⁹/L）	7.40(6.2,9.2)	6.50(5.0,12.2)	63.500	0.862
N%	78.90(70.2,92.6)	75.10(65.7,91.6)	57.500	0.603
CRP（mg/L）	33.02(4.0,86.4)	28.31(4.3,84.2)	61.000	0.751
TB（μml/L）	50.54(22.8,79.3)	56.83(14.4,107.0)	61.000	0.751
DB（μml/L）	31.76(7.1,48.8)	29.88(3.0,72.6)	63.000	0.840
ALT（U/L）	463.00(221.0,614.0)	165.00(37.0,314.0)	33.500	0.056
AST（U/L）	341.00(200.0,751.0)	152.00(31.0,207.0)	28.500	0.028
PCT（μg/L）	0.35(0.1,1.6)	1.73(0.1,6.3)	24.500	0.110

组别	开腹手术	腹腔镜手术	单纯胆囊切除	胆囊切除合并胆管取石
LCBDE组（19例）	6	13	13	6
LTCBDE组（7例）	0	7	7	0
χ²值	2.874		2.874
P值	0.146^a		0.146^b

组别	开腹手术	腹腔镜手术	单纯胆囊切除	胆囊切除合并胆管取石
LCBDE组（19例）	6	13	13	6
LTCBDE组（7例）	0	7	7	0
χ²值	2.874		2.874
P值	0.146^a		0.146^b

组别	例数	残余胆囊管长度（cm）^a	手术时间（min）^a	术中出血量（ml）^a	术后住院时间（d）^a	术后并发症（例）
LCBDE组	19	1.0±0.3	147.9±60.9	35.8±26.1	15.3±3.4	1
LTCBDE组	7	1.7±0.7	112.1±38.7	40.7±32.9	8.1±2.3	0
统计值		-2.486	1.463	-0.399	5.057	0.383
P值		0.042	0.157	0.693	<0.001	0.536

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