Clinical effect of three endoscopies combined with nasobiliary drainage through multipath in the treatment of small-diameter common bile duct stones

Abstract:

Objective：To investigate the clinical effect of multipath（cystic duct or common bile duct） and three endoscopies（la－paroscopy + choledochoscopy + duodenoscopy） combined with nasobiliary drainage and primary suture in the treatment of small-di－ameter common bile duct stones. Methods：Retrospectively analyzed clinical data of 98 patients with small-diameter common bile duct stones（≤0.8 cm） who underwent three endoscopic transcyctic common bile duct exploration/common bile duct exploration + nasobiliary drainage through abdomen + primary suture from January 2016 to December 2018 in our department. Results：All 98 pa－tients underwent operations successfully and recovered well. Among them，77 patients underwent three endoscopic transcyctic common bile duct exploration + nasobiliary drainage through abdomen + primary suture of common bile duct，while another 21 patients under－went three endoscopic common bile duct exploration + nasobiliary drainage through abdomen + primary suture. The estimated intra－operative bleeding volume was （25.0±6.5） mL and the operation time was （183.2±51.9） min. On the first day after operation，the drainage volume through abdominal cavity drainage tube was （46.5±52.4） mL；the drainage volume of nasobiliary duct was （187.3±119.8） mL. Except one patient discharged with a tube（abdominal drainage tube and nasobiliary duct），the other 97 patients removed abdominal drainage tube on （6.5±2.0） d after operation，and removed the nasobiliary tube on （5.3±1.9） d after operation. Hospital－ization time was （12.1±4.1） d. Two patients（2.0%） had postoperative bile leakage，and one of them（50%） complicated with mild peritonitis；18 patients（18.4%） complicated with mild pancre－atitis；one patient（1.0%） had residual stones（muddy stones）；one patient（1.0%） was re-operated due to obstruction of naso－biliary drainage. No complications of intestinal perforation and bleeding after operation；no conversion to laparotomy or periop－erative death. Conclusion：With the total comprehension of op－eration indication and the support of reliable endoscopic suture，simultaneous three endoscopies through multipath combined with nasobiliary drainage and primary suture is safe and feasible for treating the small-diameter common bile duct stones，and the clinical effect is good.