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首页> 外文期刊>World Journal of Surgery: Official Journal of the Societe Internationale de Chirurgie, Collegium Internationale Chirurgiae Digestivae, and of the International Association of Endocrine Surgeons >Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience.
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Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience.

机译：术前内镜括约肌切开术和腹腔镜胆囊切除术治疗胆囊胆管结石症：10年经验。

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No procedure has yet been identified as the "gold standard" for the detection and treatment of common bile duct stones (CBDS) in patients undergoing laparoscopic cholecystectomy (LC). This prospective study involves 2137 patients undergoing elective laparoscopic cholecystectomy. The algorithm for diagnostic management in place until July 1997 involved routine intravenous cholangiography and selective endoscopic retrograde cholangiography (ERC). Subsequently, assessment of the bile duct was not routinely performed, but a scoring system was applied to single out those patients at risk of CBDS who should undergo intravenous cholangiography and/or ERC (see Fig. 2). Whenever bile duct stones were found, endoscopic sphincterotomy (ES) was performed, and LC was performed with a standardized four-cannula technique after endoscopic bile duct stone clearance. Common bile duct stones were suspected in 340 patients who were referred for preoperative ERC; 250 patients were referred for ES; 21 patients were referredfor open surgery because of failure of ERC or sphincterotomy. Common bile duct stones, detected in 283 cases (13.2%), were removed before surgery in 250 cases (88.3%) and during surgery in 28 cases (9.9%). Self-limited pancreatitis occurred in 4.2% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.4% of the cases. The conversion rate was 8.3% if sphincterotomy had been performed previously and 3.4% after standard laparoscopic cholecystectomy ( p < 0.001). The morbidity rate was 4.5%; mortality, 0.09%. During follow-up five patients (0.2%) had retained stones endoscopically treated. Future trials of novel strategies for detecting and treating CBDS should compare the results of novel strategies with those of the strategy employed in this study, which includes selective ERC, preoperative ES, and LC.
机译：尚无将腹腔镜胆囊切除术（LC）患者检测和治疗胆总管结石（CBDS）的方法确定为“金标准”。这项前瞻性研究涉及2137例接受选择性腹腔镜胆囊切除术的患者。直到1997年7月，诊断管理的程序一直在进行，包括常规的静脉胆管造影术和选择性内镜逆行胆管造影术（ERC）。随后，不定期进行胆管评估，而是应用评分系统来选择那些有CBDS风险的患者，这些患者应进行静脉胆道造影和/或ERC（见图2）。每当发现胆管结石时，都会进行内窥镜括约肌切开术（ES），并在清除内窥镜胆管结石后使用标准的四插管技术进行LC。 340例术前ERC患者中怀疑有胆总管结石。 250名患者被转诊为ES;由于ERC失败或括约肌切开术，有21例患者被转诊为开放手术。术前切除胆总管结石283例（13.2％），手术前250例（88.3％），手术中28例（9.9％）。自发性胰腺炎在括约肌切开术后有4.2％的患者发生。 98.4％的患者进行了腹腔镜胆囊切除术。如果事先进行了括约肌切开术，则转换率为8.3％，而标准腹腔镜胆囊切除术后的转化率为3.4％（p <0.001）。发病率为4.5％;死亡率为0.09％。在随访期间，五名患者（0.2％）经内镜治疗保留了结石。用于检测和治疗CBDS的新策略的未来试验应将新策略的结果与本研究中使用的策略（包括选择性ERC，术前ES和LC）的结果进行比较。

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