Efficacy and safety of ultra-fine choledochoscopy through the cystic duct for treating secondary choledocholithiasis

doi:10.3877/cma.j.issn.1674-0793.2026.01.005

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of ultra-fine choledochoscopy via the cystic duct for secondary choledocholithiasis (SCL), providing clinical evidence to optimize therapeutic strategies.

Methods

A retrospective analysis was conducted on 169 patients with SCL treated in the Eighth Affiliated Hospital of Sun Yat-sen University from March 2023 to February 2025. Among them, 39 patients in the trial group underwent laparoscopic transcystic common bile duct exploration (LTCBDE) using ultra-fine choledochoscopy, while 130 patients in the control group received laparoscopic common bile duct exploration (LCBDE) with T-tube drainage plus cholecystectomy. Perioperative outcomes, including operative time, postoperative hospital stay, time to first flatus, drainage tube removal time, and 24-hour postoperative drainage volume, as well as complications such as residual stone rate, intra-abdominal bleeding, bile leakage, pulmonary infection, intra-abdominal infection, and mortality were compared between the two groups.

Results

Aside from a significantly higher proportion of patients with obstructive jaundice in the control group (P<0.05), no other differences in baseline characteristics between the two groups reached statistical significance. The trial group demonstrated significantly shorter operative time [(139.6±31.7) min vs (161.6±47.1) min, P=0.001], time to first flatus [(2.0±0.7) d vs (2.3±0.9) d, P=0.013], postoperative hospital stays [(6.1±1.8) d vs (9.8±4.1) d, P<0.0001], and drainage tube removal time [(4.0±1.5) d vs (5.5±2.4) d, P<0.001] compared to the control group. The incidence of complications or the overall complication rates (5.1% vs 10.0%) showed no statistical difference, though LTCBDE had lower rates of bile leakage (0 vs 3.1%) and residual stone rates (2.6% vs 3.1%).

Conclusions

LTCBDE combined with ultra-fine choledochoscopy significantly improves surgical efficiency and accelerates postoperative recovery in SCL patients, maintaining a favorable safety profile. This approach offers a viable and minimally invasive alternative for the management of SCL.

Key words: Ultra-fine choledochoscopy, Choledocholithiasis, Secondary, Laparoscopy

Xiyan Zheng, Dequan Yang, Ruixi Li, Xianqing Chen, Fei Du, Yun Lyu, Xianjie Shi, Shaoping Wang. Efficacy and safety of ultra-fine choledochoscopy through the cystic duct for treating secondary choledocholithiasis[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(01): 24-29.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2026.01.005

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2026/V20/I01/24

Figures/Tables 5

References 26

［1］	张井虹, 尚海涛, 刘军舰, 等. 腹腔镜胆总管一期缝合与内镜取石治疗继发性胆总管结石的临床疗效比较[J]. 中国普通外科杂志, 2021, 30(8): 877–885.
［2］	Leem G, Sung MJ, Park JH, et al. Randomized trial of prophylactic antibiotics for endoscopic retrograde cholangiopancreatography in patients with biliary obstruction[J]. Am J Gastroenterol, 2024, 119(1): 183–190.
［3］	Ma X, Cai S. The outcome and safety in laparoscopic common bile duct exploration with primary suture versus T-tube drainage: A meta-analysis[J]. Appl Bionics Biomech, 2023, 2023: 7300519.
［4］	Zaigham H, Enochsson L, Ottosson J, et al. Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass[J]. Surg Obes Relat Dis, 2023, 19(8): 882–888.
［5］	Huang J, Hu W, Liu J, et al. Laparoscopic transcystic common bile duct exploration: 8-year experience at a single institution[J]. J Gastrointest Surg, 2023, 27(3): 555–564.
［6］	Ramser B, Coleoglou Centeno A, Ferre A, et al. Laparoscopic common bile duct exploration is an effective, safe, and less-costly method of treating choledocholithiasis[J]. Surg Endosc, 2024, 38(10): 6076–6082.
［7］	Xu S, Deng C, Tang K, et al. The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis[J]. Updates Surg, 2025, 77(2): 493–499.
［8］	Zhu J, Wu H, Liu K, et al. Diagnostic performance of laparoscopic transcystic common bile duct exploration for the detection of choledocholithiasis in patients with negative MRCP[J]. Updates Surg, 2023, 75(7): 1887–1891.
［9］	Liu Y, Yang T, Liu JH, et al. Analysis of laparoscopic ultrathin choledochoscope curative effect on common bile duct exploration and choledocholithotomy in 47 cases[J]. Front Surg, 2022, 9: 782357.
［10］	Ryu S, Jo IH, Kim S, et al. Clinical impact of common bile duct angulation on the recurrence of common bile duct stone: A meta-analysis and review[J]. Korean J Gastroenterol, 2020, 76(4): 199–205.
［11］	易杰明, 曾长江, 张梦来, 等. 腹腔镜下经胆囊管柱状球囊扩张联合胆道镜胆管探查取石术同期治疗胆囊结石合并继发胆总管结石[J]. 肝胆胰外科杂志, 2024, 36(4): 241–244.
［12］	Qandeel H, Zino S, Hanif Z, et al. Basket-in-catheter access for transcystic laparoscopic bile duct exploration: technique and results[J]. Surg Endosc, 2016, 30(5): 1958–1964.
［13］	Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)[J]. Best Pract Res Clin Gastroenterol, 2006, 20(6): 1075–1083.
［14］	Boerma D, Schwartz MP. Gallstone disease. Management of common bile-duct stones and associated gallbladder stones: surgical aspects[J]. Best Pract Res Clin Gastroenterol, 2006, 20(6): 1103–1116.
［15］	李博, 贾蓬勃, 李栋, 等. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(1): 60-63.
［16］	Zhang R, Liu J, Li H, et al. Evaluation of therapeutic efficacy, safety and economy of ERCP and LTCBDE in the treatment of common bile duct stones[J]. Front Physiol, 2022, 13: 949452.
［17］	于洪武, 张芸, 代伟, 等. 腹腔镜胆总管结石手术方式的合理选择[J]. 肝胆胰外科杂志, 2014, 26(2): 140–142.
［18］	汪海, 邢跃栊. 腹腔镜联合超细胆道镜治疗胆总管结石手术效果的研究[J]. 浙江医学, 2025, 47(12): 1284–1287, 1293.
［19］	Xia HT, Liu Y, Jiang H, et al. A novel laparoscopic transcystic approach using an ultrathin choledochoscope and holmium laser lithotripsy in the management of cholecystocholedocholithiasis: An appraisal of their safety and efficacy[J]. Am J Surg, 2018, 215(4): 631–635.
［20］	黄涛, 张彦全, 弓毅. 腹腔镜下经胆囊管胆总管探查取石术的治疗进展[J]. 医学理论与实践, 2024, 37(12): 2010–2012.
［21］	宋兴超, 韩亚民, 杨伟斌, 等. 腹腔镜联合超细胆道镜治疗胆囊结石并无胆总管扩张胆总管结石的临床疗效[J]. 中国普通外科杂志, 2023, 32(12): 1965–1970.
［22］	Cohen RV, Schiavon CA, Schaffa TD, et al. Bile leakage following laparoscopic cholecystectomy[J]. Surg Endosc, 1996, 10(11): 1116–1117.
［23］	Rendell VR, Pauli EM. Laparoscopic common bile duct exploration[J]. JAMA Surg, 2023, 158(7): 766–767.
［24］	Pang L, Zhang Y, Wang Y, et al. Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysis[J]. Surg Endosc, 2018, 32(11): 4363–4376.
［25］	Zhang Z, Dong J, He X, et al. Challenges of minimally invasive treatment for acute obstructive suppurative cholangitis in elderly patients[J]. Chin Med J (Engl), 2025, 138(17): 2198–2200.
［26］	刘立民, 张宗明, 张翀, 等. 改良腹腔镜经胆囊管胆总管探查术治疗胆总管结石的疗效分析[J/OL]. 中华普通外科学文献(电子版), 2025, 19(5): 320-324.

临床参数	对照组(130例)	试验组(39例)	统计值	P值
性别^a			1.113	0.292
男	79 (60.8)	20 (51.3)
女	51 (39.2)	19 (48.7)
年龄 (岁) ^b	55.2±14.8	53.4±13.3	0.684	0.496
ALT (U/L)^b	251.7±235.5	271.5±246.1	0.457	0.648
AST (U/L)^b	234.2±343.6	188.3±250.8	0.774	0.440
总胆红素 (μmol/L)^b	50.3±38.5	41.1±40.1	1.287	0.200
直接胆红素(μmol/L)^b	24.3±25.3	16.9±22.0	1.638	0.103
胆结石直径 (mm)^b	5.5±1.8	5.7±1.5	0.686	0.494
胆总管直径 (mm)^b	10.3±3.7	9.7±3.0	0.816	0.416
合并胆源性胰腺炎^a	26 (20.0)	5 (12.8)	1.032	0.310
合并梗阻性黄疸^a	62 (47.7)	10 (25.6)	5.966	0.015 ^c
合并基础疾病^a
高血压	31 (23.8)	10 (25.6)	0.010	0.921
糖尿病	26 (20.0)	8 (20.5)	0.005	0.944
冠心病	26 (20.0)	3 (7.7)	3.197	0.074
ERCP史	2 (1.5)	0 (0)	0.607	0.436

临床参数	对照组(130例)	试验组(39例)	统计值	P值
性别^a			1.113	0.292
男	79 (60.8)	20 (51.3)
女	51 (39.2)	19 (48.7)
年龄 (岁) ^b	55.2±14.8	53.4±13.3	0.684	0.496
ALT (U/L)^b	251.7±235.5	271.5±246.1	0.457	0.648
AST (U/L)^b	234.2±343.6	188.3±250.8	0.774	0.440
总胆红素 (μmol/L)^b	50.3±38.5	41.1±40.1	1.287	0.200
直接胆红素(μmol/L)^b	24.3±25.3	16.9±22.0	1.638	0.103
胆结石直径 (mm)^b	5.5±1.8	5.7±1.5	0.686	0.494
胆总管直径 (mm)^b	10.3±3.7	9.7±3.0	0.816	0.416
合并胆源性胰腺炎^a	26 (20.0)	5 (12.8)	1.032	0.310
合并梗阻性黄疸^a	62 (47.7)	10 (25.6)	5.966	0.015 ^c
合并基础疾病^a
高血压	31 (23.8)	10 (25.6)	0.010	0.921
糖尿病	26 (20.0)	8 (20.5)	0.005	0.944
冠心病	26 (20.0)	3 (7.7)	3.197	0.074
ERCP史	2 (1.5)	0 (0)	0.607	0.436

组别	腹腔出血	胆漏	肺部感染	腹腔感染	胆道狭窄	胆道损伤	结石残留	病死	合计
对照组(130例)	0(0)	4(3.1)	2(1.5)	1(0.8)	2(1.5)	0(0)	4(3.1)	0(0)	13(10.0)
试验组(39例)	0(0)	0(0)	1(2.6)	0(0)	0(0)	0(0)	1(2.6)	0(0)	2(5.1)
χ²值	-	1.229	0.181	0.302	0.607	-	0.027	-	0.938
P值	-	0.268	0.671	0.583	0.436	-	0.868	-	0.525

组别	腹腔出血	胆漏	肺部感染	腹腔感染	胆道狭窄	胆道损伤	结石残留	病死	合计
对照组(130例)	0(0)	4(3.1)	2(1.5)	1(0.8)	2(1.5)	0(0)	4(3.1)	0(0)	13(10.0)
试验组(39例)	0(0)	0(0)	1(2.6)	0(0)	0(0)	0(0)	1(2.6)	0(0)	2(5.1)
χ²值	-	1.229	0.181	0.302	0.607	-	0.027	-	0.938
P值	-	0.268	0.671	0.583	0.436	-	0.868	-	0.525

[1]	Xiaosi Hu, Huichun Liu. Functional preservation of Oddi sphincter in minimally invasive treatment for choledocholithiasis [J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(01): 6-9.
[2]	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.
[3]	Chunyu Li, Meng Yang. Current application and future prospects of total parathyroidectomy in secondary hyperparathyroidism [J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(01): 66-72.
[4]	Bin Liu, Wei Wang, Jun Ren, Liuhua Wang, Daorong Wang. Evaluation of clinical feasibility and postoperative effects of laparoscopic modified Devine procedure for patients with advanced gastric cancer with pyloric obstruction [J]. Chinese Archives of General Surgery(Electronic Edition), 2025, 19(06): 369-375.
[5]	Shun Xu, Han Wang, Tao Hu, Mengjia Qian, Yiyao Cui, Xinhao Chen. Comparison of therapeutic effects and prognosis between two surgical methods for patients with stones in the middle and lower segments of the common bile duct combined with acute cholangitis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(01): 38-41.
[6]	Yiyang Tian, Han Li, Xiefen Hu, Xianhui Hu, xin Qin, Lihai Jiang, Zhiyuan Xie, Daichun Li, Yong Yin. Comparison of two single-layer approaches in retroperitoneal laparoscopic adrenalectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(01): 77-83.
[7]	Yang Wang, Zhihang Ni, Chunlai Shao, Boxin Xue, Xiaolong Liu. Preliminary study of laparoscopic radiofrequency ablation of sympathetic nerve in the renal artery for refractory hypertension [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(06): 742-746.
[8]	Chao Zhi, Bin Cao, Liang Xiao, Jia Wu, Wenjun Xue, Chao Zhang, Fei Guo, Bo Yang. Study on the effectiveness of a novel dual channel laparoscopic smoke evacuation device [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(06): 778-783.
[9]	Xiaoying Zhong, Yang Cao, Xin Yu, Honghui Shi, Haiyuan Liu. Comparison of efficacy and safety between single-port and multi-port laparoscopy in the removal of large uterine fibroids [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 348-353.
[10]	Zhigang Ma, Yupeng Li, Maimaitinijati YusufuKadir, Jianhao Liang, Chao Ma, Jie Zhang, Yuan Meng, Xiong Chen. The application of laparoscopy combined with ultrasound in the diagnosis and treatment of idiopathic retroperitoneal fibrosis [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 369-373.
[11]	Yuan Que, Zengjiang Zhao, Xiao Zheng, Congyun Huang, Zaixing Ouyang, Wenying Liu. Application of head-mounted naked-eye 3D endoscopic display system in laparoscopic hepatectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(01): 59-65.
[12]	Xingfu Duan, Jianzhong Tang, Zhiwei Sun, Yesheng Chen, Bo Gao, Zhenhao Fei. Clinical efficacy of laparoscopic microwave ablation via retroperitoneal approach for recurrent hepatocellular carcinoma [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 919-924.
[13]	Xin Tang, Zilong Guan, Shuang Zhu, Fangzhou Liu, Guodong Sun, Tianyang Wang, Yunhao Shi, Haonan Qi, Yunxiao Liu, Jiaqi Wang, Ziming Yuan, Weiyuan Zhang, Rui Huang. Comparative analysis of short-term efficacy between domestic surgical robots and laparoscopy in postoperative rectal cancer patients [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(06): 516-525.
[14]	Mengzhe Li, Hong Liang, Wei Zheng, Xi Wang, Zhanpeng Yang, Qingwen Fan, Chao Zhang. Analysis of 37 cases of the application value of transanal assistance in laparoscopic transabdominal ISR sphincter-preserving surgery for low rectal cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(06): 552-558.
[15]	Guanghua Chu, Chunyan Hu, Qi Deng. Clinical efficacy and reproductive prognosis of laparoscopic segmental tubal resection with end-to-end anastomosis versus laparoscopic salpingotomy in patients with tubal pregnancy [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(10): 767-771.

Please choose a citation manager

Content to export