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首页> 外文期刊>Surgical Endoscopy >Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy.
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Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy.

机译：一次腹腔镜胆囊切除术和围手术期内镜括约肌切开术联合处理胆总管结石。

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BACKGROUND: Laparoscopic cholecystectomy (LC) has become the reference treatment for biliary lithiasis, but the management strategy for common bile duct stones (CBDS) remains a subject of controversy in the absence of an established consensus. While conventional surgery remains the reference treatment for CBDS, minimally invasive techniques are becoming more and more popular. These methods consist of the extraction of the common bile duct stones either exclusively by laparoscopy or by sequential treatment with endoscopic sphincterotomy (ES) followed by LC. The aim of this study was to evaluate the treatment of CBDS in a one-stage operation by laparoscopic cholecystectomy (LC) and perioperative endoscopic sphincterotomy. PATIENTS AND METHODS: Between January 1994 and March 1998, 44 patients, 20 male and 24 female, (sex ratio 1.2) with a median age of 57 years (range 28-84 years) were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 39 cases (88%) and associated with a complication in 5 cases (12%), namely, cholangitis (2 cases) or acute pancreatitis (3 cases). The perioperative ES was performed immediately after the LC during the same operative time, with perioperative cholangiography being systematically performed (1 failure). In 6 cases, a transcystic drain was left in place (to ensure complete evacuation of the CBDS postoperatively) when there were more than three stones and/or when they were larger than 6 mm. The patient was positioned in the left lateral position in order to perform the ES. RESULTS: Mean operative time for LC was 60 min, range 40-90 min. The general anesthesia was prolonged by 40 min in order to perform an ES (range 30-60 min).The perioperative ES was unsuccessful in one case (2%), due to the impossibility of catheterizing the papilla, the preoperative MR cholangiogram being normal. Immediate clearance of the CBD was achieved in 95% of the cases (42 p). In 2 cases, residual stone was found in the sixth day after cholangiography and was spontaneously evacuated as shown by 21st-day control. There was no mortality or postoperative complications. The duration of the postoperative hospitalization was 4.6 days (range 3-6). CONCLUSIONS: We believe that LC combined with perioperative ES is a quick, reliable, and safe technique for the treatment of CBDS during a single operative procedure, although this approach is limited by the proximity and availability of an endoscopic team.
机译：背景：腹腔镜胆囊切除术（LC）已成为胆道结石的参考治疗方法，但是在没有公认的共识的情况下，胆总管结石（CBDS）的治疗策略仍然是一个有争议的话题。尽管常规手术仍然是CBDS的参考治疗方法，但微创技术正变得越来越流行。这些方法包括仅通过腹腔镜或通过内镜括约肌切开术（ES）继之以LC依次治疗来提取胆总管结石。这项研究的目的是评估通过腹腔镜胆囊切除术（LC）和围手术期内镜括约肌切开术在一阶段手术中对CBDS的治疗。患者与方法：在1994年1月至1998年3月之间，对中位年龄为57岁（28-84岁）的44例患者（男性20例，女性24例，性别比1.2）进行了可疑或确诊的CBDS治疗。 CBDS无并发症39例（88％），并发并发症5例（1​​2％），即胆管炎（2例）或急性胰腺炎（3例）。围手术期ES在LC手术后立即在同一手术时间内进行，并在手术期间进行了胆道造影（1次失败）。在6例中，当结石多于三个和/或结石大于6 mm时，留在经囊腔引流（以确保术后CBDS完全排出）。将患者置于左侧位置以进行ES。结果：LC的平均手术时间为60分钟，范围为40-90分钟。为了进行ES，全身麻醉延长了40分钟（范围为30-60分钟）。由于无法插入乳头，术前MR胆管造影正常，其中1例（2％）围手术期ES未成功。 95％的病例（42 p）立即清除了CBD。在2例中，胆道造影后第六天发现残留的结石，并如第21天的对照所示自发排空。没有死亡或术后并发症。术后住院时间为4.6天（范围3-6）。结论：我们认为，LC与围手术期ES结合是一种在单次手术过程中治疗CBDS的快速，可靠和安全的技术，尽管这种方法受到内镜团队的邻近性和可用性的限制。

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