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首页> 外文期刊>Surgical Endoscopy >Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones.
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Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones.

机译：腹腔镜经囊性胆管探查术：胆总管结石的首选治疗方法。

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BACKGROUND: This study was designed to explore the role of transcystic bile duct exploration (TCE) as a first line of treatment for patients with suspected or incidental common bile duct (CBD) stones. METHODS: A prospective, case-control study of clinically comparable groups of patients who underwent laparoscopic cholecystectomy (LC) alone (n = 1,854) and combined LC/TCE for CBD stones (n = 253) under the care of one surgeon was performed. Other than ultrasonography, no routine preoperative imaging was used; however, we performed routine intraoperative cholangiography on all patients. RESULTS: There was no difference in age (49 +/- 15 vs. 57 +/- 19, p = 0.7), sex (79% vs. 82% females, p = 0.6), and ASA grade (1.9 +/- 1 vs. 1.8 +/- 1, p = 0.7). A larger proportion of the TCE group presented as an emergency (TCE 45% vs. LC alone 27%, p = 0.03) and more often presented with acute biliary pain compared with LC alone (27% vs. 13%, p = 0.02). Although a majority of the patients in the TCE group had clinical or biochemical risk factors for CBD stones (86%), only 27% had suspected stones on preoperative ultrasound. The incidence of jaundice (6% vs. 20%, p = 0.01) was lower in the LC alone group compared with TCE patients. Previous abdominal surgery was noted in 34% patients who underwent LC alone and 30% in LC/TCE (p = 0.06). Significantly there was no difference in open conversion between the two groups (LC alone 0.5% vs. LC/TCE 0.6%, p = 0.07). Comparison of selected outcome parameters for LC versus TCE showed a postoperative hospital stay of 2 (1-14) vs. 2 (1-17) days (p = 0.07), presentation to resolution 1 (1-11) vs. 1 (1-11) weeks (p = 0.07), and morbidity 1.07% vs. 1.2% (p = 0.07). CONCLUSIONS: The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones.
机译：背景：本研究旨在探讨经囊性胆管探查（TCE）作为疑似或偶然胆总管（CBD）结石患者的一线治疗的作用。方法：进行了一项前瞻性，病例对照研究，对一组在临床上可比较的患者进行了单独的腹腔镜胆囊切除术（LC）（n = 1,854），并在一名外科医生的护理下对LC / TCE联合CBD结石（n = 253）。除超声检查外，无常规术前影像检查。但是，我们对所有患者进行了常规术中胆道造影。结果：年龄（49 +/- 15 vs. 57 +/- 19，p = 0.7），性别（79％和82％的女性，p = 0.6）和ASA等级（1.9 +/-）没有差异。 1比1.8 +/- 1，p = 0.7）。与单独使用LC相比，TCE组中有较大比例的患者表现为紧急情况（TCE为45％，而单独使用LC为27％，p = 0.03），更常出现急性胆道疼痛（27％vs. 13％，p = 0.02） 。尽管TCE组中的大多数患者都有CBD结石的临床或生化危险因素（86％），但只有27％的患者在术前超声检查中怀疑有结石。与TCE患者相比，仅LC组的黄疸发生率较低（6％vs. 20％，p = 0.01）。 34％单独接受LC和30％接受LC / TCE的患者曾接受过腹部手术（p = 0.06）。值得注意的是，两组之间的开放转化率没有差异（仅LC为0.5％，LC / TCE为0.6％，p = 0.07）。 LC和TCE的选定结局参数比较显示，术后住院时间为2（1-14）天与2（1-17）天（p = 0.07），显示为解决方案1（1-11）vs. 1（1 -11）周（p = 0.07），发病率为1.07％对1.2％（p = 0.07）。结论：该研究提倡采用单次腹腔镜胆囊切除术并经囊性CBD探查作为可行的首选治疗方法，并且是治疗CBD结石患者的合理下一步。

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