Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
Thirty patients of primary cholangiolithiasis were treated by the use of a rigid choledochoscope passing through the left lateral liver lobe for removal. 20 cases of them were manipulated with mini-incisions, the stones in 14 patients (70.0%) were completely removed. In the remaining 10 cases of conventional laparotomy, left lateral liver incised in 4, left lateral lobectomy in 6 before rigid choledochoscopic lithotomy; the stons were completely removed in eight patients (80.0%). No case had complications, the short-term effect of the method is obviously better than that of other various operative treatments. It has the advantages of less trauma, less pain, and quick recovery. It is a economical and effective new technique and has prospects of application.
Objective To investigate the clinical significance of routine application of choledochoscope during operation of biliary duct. Methods The clinical data of 136 patients with the routine application of intraoperative choledochoscope dealing with bile duct diseases in this hospital from October 2003 to July 2009 were analyzed and summarized. Results Intraoperative choledochoscope inspection, taking stones and targeted surgery were performed in 116 cases with extrahepatic and (or) intrahepatic bile duct stones. The taking out rate of extrahepatic bile duct stones was 100% (85/85), the residual stone rates of extrahepatic and intrahepatic bile duct were 0 (0/85) and 22.6% (7/31), respectively, with the total residual stone rate was 6.0% (7/116). By using intraoperative choledochoscope, benign intrahepatic bile duct stricture was found in 13 cases, malignant extrahepatic and intrahepatic bile duct stricture in 8 cases. Four cases of hilar cholangiocarcinoma and 4 cases of common bile duct cancer, 2 cases of lower segment of common bile duct polyp, 3 cases of hepatolithiasis with the left hepatic bile duct carcinoma were diagnosed by biopsy via choledochoscope. Causes were confirmed by applying choledochoscope in 16 patients with obstructive jaundice. The use of choledochoscope with surgical treatment enabled benign and malignant bile duct stricture to achieve good results, without serious complications such as bile duct dilaceration, subphrenic abscess or acute cholangitis. Conclusions Using choledochoscope can tremendously reduce the residual rate of stone in biliary duct surgery, increase the definite diagnosis rate of biliary duct diseases and play a role of reasonable instruction in its treatment options. It has unique advantages in identifying causes of jaundice. It is remarkable that the role of applying choledochoscope to diagnose and cure biliary duct diseases. It should be widely used.
ObjectiveTo investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).MethodsThe clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.ResultsOf the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.ConclusionsUltrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.
ObjectiveTo evaluate the clinical utility of combining laparoscopic common bile duct exploration (LCBDE) with intraoperative endoscopic antegrade nasobiliary drainage (EANBD) for choledocholithiasis. MethodsPatients with choledocholithiasis who underwent LCBDE at Guanghan People’s Hospital from December 2023 to June 2025 were retrospectively enrolled and categorized into an EANBD group and a T-tube drainage group. Intraoperative and postoperative clinical indicators were compared between the two groups. MethodsBased on the inclusion and exclusion criteria, a total of 121 patients were enrolled, with 57 in the EANBD group and 64 in the T-tube drainage group. There were no significant differences in preoperative baseline data such as demographic characteristics, preoperative comorbidities, routine blood parameters, liver function, and morphological measurements of the bile duct and stones between the two groups (all P>0.05). Compared with the T-tube drainage group, the EANBD group showed significantly longer operative time, abdominal drainage duration, and postoperative hospital stay [110.0 (94.5, 127.5) min vs. 85.0 (75.0, 95.0) min; 7.0 (6.0, 8.0) d vs. 6.0 (6.0, 6.0) d; and 8.0 (7.0, 9.0) d vs. 7.0 (7.0, 7.0) d, all P<0.001]. However, the EANBD group had significantly shorter biliary drainage tube indwelling time, lower pain point on postoperative day 2, and reduced biliary drainage volume on both postoperative days 2 and 3 [6.0 (6.0, 7.0) d vs. 60.0 (56.0, 65.0) d, P<0.001; 3 (2, 4) vs. 4 (3, 5), P=0.007; 300 (200, 500) mL vs. 400 (300, 500) mL, P=0.016; and 300 (200, 400) mL vs. 410 (300, 600) mL, P=0.002]. No statistically significant differences were found between the EANBD and T-tube drainage groups regarding bile leakage (3 cases vs. 2 cases, P=0.895), intra-abdominal infection/abscess (1 case vs. 0 case, P=0.471), electrolyte metabolism disorders (4 cases vs. 11 cases, P=0.090), residual stones (1 case vs. 2 cases, P=1.000), or accidental tube dislodgment (3 cases vs. 1 case, P=0.531). During the 6-month postoperative follow-up, 95 patients (follow-up rate was 78.5%) underwent abdominal ultrasound or magnetic resonance cholangiopancreatography re-examination, and no complications such as biliary strictures were observed. ConclusionsFor choledocholithiasis treated via LCBDE, EANBD after operation shows advantages such as postoperative lower pain pionts, shorter indwelling tube duration. It serves as a safe and effective alternative to T-tube drainage in selected patients, which can shorten the indwelling tube duration and improve patients’ quality of life.
To evaluate the efficacy and safety of ultrathin choledochoscopy for patients with gallbladder stones complicated by non-dilated extrahepatic bile duct stones. MethodsThis retrospective study included patients with gallbladder stones complicated by non-dilated extrahepatic bile duct stones who were treated at the Department of Hepatobiliary and Pancreatic Surgery, Huai’an Clinical College of Xuzhou Medical University, from January 2024 to December 2025. Patients were divided into two groups based on different treatment strategies: the ultrathin choledochoscopy group (n=66) underwent laparoscopic cholecystectomy (LC) combined with transcystic ultrathin choledochoscopy for common bile duct stone extraction; the endoscopic group (n=61) received LC combined with intraoperative endoscopic retrograde cholangiopancreatography. Clinical outcomes were compared between the two groups. ResultsA total of 127 patients were enrolled, including 66 in the ultrathin choledochoscopy group and 61 in the endoscopic group. Compare with endoscopic group, the ultrathin choledochoscopy group exhibited significantly shorter operation time [(82.15±17.87) min vs. (104.26±23.99) min, P＜0.001], shorter time to first postoperative flatus [(1.77±0.78) d vs. (2.19±0.79) d, P=0.004], and shorter length of hospital stay [(4.98±1.99) d vs. (5.89±2.65) d, P=0.032]; lower white blood cell count [(9.95±2.57)×10?/L vs. (11.09±3.28)×10?/L, P=0.033], neutrophil count [(7.20±2.26)×10?/L vs. (8.22±2.58)×10?/L, P=0.021], hypersensitive C-reactive protein [(39.79±17.58) mg/L vs. (48.43±20.04) mg/L, P=0.012] on postoperative day 1; lower total hospital costs [(2.00±0.26)×104 yuan vs. (2.64±0.32)×104 yuan, P＜0.001], as well as a lower total complication rate [1.52% (1/66) vs. 10.53% (6/57), P=0.048]. The ultrathin choledochoscopy group achieved a higher surgical success rate than the endoscopic group [100% (66/66) vs. 93.44% (57/61), P=0.049]. During the follow-up, no patients in either group presented with bile duct stricture, reflux cholangitis, or stone recurrence. ConclusionThe ultrathin choledochoscopy approach via the cystic duct has advantages in operative duration, early postoperative recovery, and total hospital costs, and provides a novel treatment option for patients with gallbladder stones complicated by non-dilated extrahepatic bile duct stones.