Experience in treatment of 326 patients with gallstones

Objective To investigate the feasibility of clinical staging and standardization of therapy for patients with gallstones.Methods The clinical data of 326 cases of gallstones treated in our hospital from January 2012 to December 2013 were collected.Appropriate surgical procedures were selected based on preoperative staging(stags Ⅰ-Ⅳ) that was conducted according to the degree of pathological damage in the gallbladder.Clinical efficacy was observed for assessment.Results Among 57 patients categorized as stage I,53 cases received choledochoscopy by small incision for preservation of the gallbladder,including 3 cases converted to cholecystostomy and 1 case of recurrent gallstones one year later; laparoscopic cholecystectomy was performed in the remaining 4 cases.A total of 152 patients were categorized as stageⅡ: 122 cases received laparoscopic cholecystectomy,of which 2 cases were converted to open cholecystectomy,2 cases developed bile leakage,and none suffered serious complication of bile duct injury; open cholecystectomy was performed in the other 30 cases in category II,2of which had fat liquefaction at the incision,but complications of bile leakage and bile duct injury were not observed.There were 87 patients with stage Ⅲ disease: among 50 cases who received open cholecystectomy,3 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed; in the remaining 37 cases who received open choledochoscope-assisted cholecystostomy,7 cases developed fat liquefaction at the incision,and 10 cases eventually underwent open cholecystectomy three months after the operation due to cystic duct closure and opening abnormality detected by angiography.Thirty patients with stage IV disease underwent cholecystectomy and choledocholithotomy,of which 2 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed.All326 patients were cured without mortality.The incidence of adverse events was 6.75%.Conclusion The standardization of therapy for patients with gallstones is an effective approach to ensure the clinical efficacy and to avoid or reduce postoperative complications.It should be promoted in clinical settings.