腹腔鏡下経胆嚢管的除石術の検討

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  • EFFECTIVENESS AND LONG-TERM OUTCOMES OF LAPAROSCOPIC TRANSCYSTIC DUCT LITHOTOMY

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Laparoscopic exploration of the common bile duct (CBD) is slowly gaining in popularity. The aim of this study was to evaluate the efficacy of transcystic duct approach (TC). We experienced a total of 300 cases of CBD stones which were managed laparoscopically. The procedure was completed laparoscopically in 295 cases (98.3%), with TC in 140 cases, and with choledochotomy in 145 cases. TC was successful in 140 of 195 patients (68.2%). New technique and equipment improved the success rate up to more than 90%. Two management options were compared as to operation time, lengths of hospital stay, postoperative complications and recurrence of stones. TC showed significantly short operating time, short hospital stay, low morbidity rate and low recurrence rate compared with those of choledochotomy. TC proved its safty and efficacy. Another advantage is that it leaves lower choledochal sphincter intact. This is an important benefit, especially for young adults. An investigation of learning curve disclosed that each surgeon would require experiences with approximately 50 cases to become skillful.<br> In our opinion, TC should be the treatment of choice whenever possible.

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