Abstract：
OBJECTIVE: In patients with gallstones complicated by common bile duct (CBD) stones, both normal and dilated common bile ducts have been reported. The goal of this study was to investigate the efficacy and safety of primary suturing after microincision of the cystic duct confluence in treating these patients.
METHODS: Between July 2018 and December 2021, 104 patients were admitted to the Department of General Surgery at Guannan County People\'s Hospital with gallstone complications, and their records were reviewed retrospectively. The patients were divided into 2 groups: normal CBD group (n=70, CBD diameter: 6.0 to 8.0 mm) and dilated CBD group (n=34, CBD diameter: >8.0 mm). In these 104 patients, there were 75 cases of CBD stones with acute cholangitis, 12 cases of CBD stones without cholangitis, and 17 cases of mild biliary pancreatitis with CBD stones (including 2 cases of biliary pancreatitis with cholangitis). Among all patients, there were 37 cases with jaundice, 67 cases without jaundice, and 5 cases of emergency surgery. All patients underwent microincision of the cystic duct confluence followed by primary suturing. Both groups were compared on a variety of general and perioperative indicators.
RESULTS: All patients underwent laparoscopy combined with choledochoscopy; there were no cases of biliary tract injury or conversion to laparotomy. There was no statistically significant difference in operation duration ( P =0.286), blood loss ( P =0.06), length of stay ( P =0.821), and time to drainage tube removal ( P =0.096) between the 2 groups.
CONCLUSIONS: Microincision of the cystic duct confluence, followed by a primary suture, is a safe and effective treatment for CBD stones in patients with a normal CBD diameter, as determined by preoperative imaging.
METHODS: Between July 2018 and December 2021, 104 patients were admitted to the Department of General Surgery at Guannan County People\'s Hospital with gallstone complications, and their records were reviewed retrospectively. The patients were divided into 2 groups: normal CBD group (n=70, CBD diameter: 6.0 to 8.0 mm) and dilated CBD group (n=34, CBD diameter: >8.0 mm). In these 104 patients, there were 75 cases of CBD stones with acute cholangitis, 12 cases of CBD stones without cholangitis, and 17 cases of mild biliary pancreatitis with CBD stones (including 2 cases of biliary pancreatitis with cholangitis). Among all patients, there were 37 cases with jaundice, 67 cases without jaundice, and 5 cases of emergency surgery. All patients underwent microincision of the cystic duct confluence followed by primary suturing. Both groups were compared on a variety of general and perioperative indicators.
RESULTS: All patients underwent laparoscopy combined with choledochoscopy; there were no cases of biliary tract injury or conversion to laparotomy. There was no statistically significant difference in operation duration ( P =0.286), blood loss ( P =0.06), length of stay ( P =0.821), and time to drainage tube removal ( P =0.096) between the 2 groups.
CONCLUSIONS: Microincision of the cystic duct confluence, followed by a primary suture, is a safe and effective treatment for CBD stones in patients with a normal CBD diameter, as determined by preoperative imaging.
摘要：
目的：在胆结石并发胆总管（CBD）结石的患者中，已报道了正常和扩张的胆总管。这项研究的目的是研究胆囊管汇合微切口后初次缝合治疗这些患者的疗效和安全性。
方法：2018年7月至2021年12月，灌南县人民医院普外科收治胆结石并发症患者104例，和他们的记录进行了回顾性审查。将患者分为2组：正常CBD组（n=70，CBD直径：6.0至8.0mm）和扩张CBD组（n=34，CBD直径：>8.0mm）。在这104名患者中，有75例CBD结石伴急性胆管炎，12例CBD结石无胆管炎，轻度胆源性胰腺炎合并CBD结石17例(其中胆源性胰腺炎合并胆管炎2例)。在所有患者中，有37例黄疸，67例无黄疸,5例急诊手术。所有患者均行胆囊管汇合的微切口，然后进行初次缝合。比较两组患者的各项一般情况及围手术期指标。
结果：所有患者均行腹腔镜联合胆道镜检查，无一例胆道损伤或中转开腹。手术时间差异无统计学意义(P=0.286)。失血量（P=0.06），住院时间（P=0.821），两组间引流管拔除时间(P=0.096)。
结论：胆囊管汇合的微切口，然后是初级缝线，是CBD直径正常的患者的CBD结石的安全有效治疗方法，由术前影像学确定。
方法：2018年7月至2021年12月，灌南县人民医院普外科收治胆结石并发症患者104例，和他们的记录进行了回顾性审查。将患者分为2组：正常CBD组（n=70，CBD直径：6.0至8.0mm）和扩张CBD组（n=34，CBD直径：>8.0mm）。在这104名患者中，有75例CBD结石伴急性胆管炎，12例CBD结石无胆管炎，轻度胆源性胰腺炎合并CBD结石17例(其中胆源性胰腺炎合并胆管炎2例)。在所有患者中，有37例黄疸，67例无黄疸,5例急诊手术。所有患者均行胆囊管汇合的微切口，然后进行初次缝合。比较两组患者的各项一般情况及围手术期指标。
结果：所有患者均行腹腔镜联合胆道镜检查，无一例胆道损伤或中转开腹。手术时间差异无统计学意义(P=0.286)。失血量（P=0.06），住院时间（P=0.821），两组间引流管拔除时间(P=0.096)。
结论：胆囊管汇合的微切口，然后是初级缝线，是CBD直径正常的患者的CBD结石的安全有效治疗方法，由术前影像学确定。
