JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B

Accepted manuscript available online (unedited version)

Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage

Author(s): Song-mei Lou, Min Zhang, Zheng-rong Wu, Gui-xing Jiang, Hua Shen, Yi Dai, Yue-long Liang, Li-ping Cao, Guo-ping Ding
Affiliation(s): Department of Hepatobiliary & Pancreatic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; more
Corresponding email(s): dinguop@zju.edu.cn
Key Words: Choledochoscope; Gastroscope; laparoscopic common bile duct exploration (LCBDE); Nasobiliary drainage

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Song-mei Lou, Min Zhang, Zheng-rong Wu, Gui-xing Jiang, Hua Shen, Yi Dai, Yue-long Liang, Li-ping Cao, Guo-ping Ding. Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage[J]. Journal of Zhejiang University Science B,in press.Frontiers of Information Technology & Electronic Engineering,in press.https://doi.org/10.1631/jzus.B1900060

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author="Song-mei Lou, Min Zhang, Zheng-rong Wu, Gui-xing Jiang, Hua Shen, Yi Dai, Yue-long Liang, Li-ping Cao, Guo-ping Ding",
journal="Journal of Zhejiang University Science B",
year="in press",
publisher="Zhejiang University Press & Springer",
doi="https://doi.org/10.1631/jzus.B1900060"
}

%0 Journal Article
%T Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage
%A Song-mei Lou
%A Min Zhang
%A Zheng-rong Wu
%A Gui-xing Jiang
%A Hua Shen
%A Yi Dai
%A Yue-long Liang
%A Li-ping Cao
%A Guo-ping Ding
%J Journal of Zhejiang University SCIENCE B
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doi="https://doi.org/10.1631/jzus.B1900060"

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T1 - Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage
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A1 - Zheng-rong Wu
A1 - Gui-xing Jiang
A1 - Hua Shen
A1 - Yi Dai
A1 - Yue-long Liang
A1 - Li-ping Cao
A1 - Guo-ping Ding
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PB - Zhejiang University Press & Springer
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Abstract
Chinese Summary
Academic Network
Reviewer Comment

Abstract: Common bile duct (CBD) stones are a frequent problem in Chinese populations, and their incidence is particularly high in certain areas (Wang et al., 2013). In recent years, laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) have been the main surgical procedures for CBD stones, although each has different advantages and disadvantages in the treatment of choledocholithiasis (Loor et al., 2017; Zhou et al., 2017). For patients with large stones, a dilated CBD, especially concurrent gallstones, LCBDE is the preferred and most economical minimally invasive procedure (Koc et al., 2013). However, a T-tube is often placed during LCBDE to prevent postoperative bile leakage; this is associated with problems such as bile loss, electrolyte disturbance, and decreased gastric intake (Martin et al., 1998). In addition, the T-tube usually must remain in place for more than a month, during which time the patient’s quality of life is seriously compromised. Many skilled surgeons currently perform primary closure of the CBD following LCBDE, which effectively speeds up rehabilitation (Hua et al., 2015). However, even in sophisticated medical centers, the incidence of postoperative bile leakage still reaches ≥10% (Liu et al., 2017). Especially for a beginner, bile leakage remains a key problem (Kemp Bohan et al., 2017). Therefore, a safe and effective minimally invasive surgical approach to preventing bile leakage during primary closure of the CBD after LCBDE is still urgently needed.

胃镜联合胆道镜在腹腔镜胆总管探查术中的应用

目的:通过探讨胃镜联合胆道镜在腹腔镜胆总管探查术(LCBDE)中的应用,为胆总管结石的手术治疗提供更多的手术方式,改善患者生活质量,降低手术难度.
创新点:摒弃了以往LCBDE术后需行T管引流的方式,以鼻胆管代替T管,改善患者生活质量.同时胃镜的操作难度较内镜逆行胰胆管造影(ERCP)低.因此,本手术方式可以得到更好的推广.
方法:研究对象为2017年7月1日至2017年10月30日于浙江大学医学院附属邵逸夫医院就诊的胆总管结石患者.收集这些患者的年龄、性别等临床数据,排除那些不能耐受麻醉、患急性胰腺炎及急性胆管炎、并发肝内胆管结石及胆总管结石呈泥沙状或者絮状的患者.对患者行胃镜联合胆道镜的LCBDE手术,统计其手术时长、术中出血量、术后并发症、术后住院时长以及住院花费.
结论:胃镜联合胆道镜放置鼻胆管在预防LCBDE术后胆漏上切实有效,且由于术后无需留置T管,对患者的生活质量有所改善.同时,本手术方式对手术操作技术的要求较低,对于初学胆总管一期缝合的医师来说,可降低其术后胆漏的概率.
关键词组：胆道镜;胃镜;腹腔镜胆总管探查术(LCBDE);鼻胆管引流

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Reference

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胃镜联合胆道镜在腹腔镜胆总管探查术中的应用

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