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首页> 外文期刊>Surgical Endoscopy >Cholecystocholedocholithiasis: a case-control study comparing the short- and long-term outcomes for a 'laparoscopy-first' attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy).
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Cholecystocholedocholithiasis: a case-control study comparing the short- and long-term outcomes for a 'laparoscopy-first' attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy).

机译：胆囊胆管结石症：一项病例对照研究，比较了“腹腔镜优先”态度的短期和长期预后与序贯治疗的结果（系统性内窥镜括约肌切开术，然后进行腹腔镜胆囊切除术）。

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BACKGROUND: No unanimous consensus has been achieved regarding the ideal management of cholecystocholedocholithiasis. The treatment of gallbladder and common bile duct (CBD) stones may be achieved currently according to a two-step-protocol (endoscopic sphincterotomy associated with laparoscopic cholecystectomy) or by a one-step laparoscopic procedure, including exploration of the CBD and cholecystectomy. Endoscopic sphincterotomy is reported to have considerable morbidity/mortality and CBD stone recurrence rates, whereas laparoscopic CBD clearance is a demanding procedure, which to date has not spread beyond specialized environments. METHODS: To evaluate our "laparoscopy first" (LF) approach for patients affected by gallbladder/CBD stones (laparoscopic exploration and intraoperative decision whether to proceed with laparoscopic CBD exploration or to postpone CBD stone treatment to a postoperative endoscopic retrograde cholangiopancreatography [ERCP]), we performed a retrospective, two-center case-control comparison of the postoperative outcome for 49 consecutive patients treated for gallbladder/CBD stones from January 2000 through December 2004. The results obtained with this LF approach were compared with those achieved with the traditional, "endoscopy-first" (EF) approach (ERCP plus endoscopic sphincterotomy, followed by laparoscopic cholecystectomy). The mean follow-up period was 6.4 years (range, 4-8 years). RESULTS: No difference emerged concerning early and late complications, mortality, or laparotomies needed to accomplish cholecystectomy and CBD clearance. The postoperative hospital stay was shorter for the LF group. In the LF group, only 22 patients underwent choledochotomy (45%), and 15 patients underwent perioperative ERCP (30%). Conversions decreased with practice. After choledochotomy, an increasing number of patients underwent primary closure of the CBD (with no biliary drain), without complications. CONCLUSIONS: An LF approach to gallbladder/CBD stones is safe and feasible. It may allow the majority of surgeons to avoid excessively difficult/dangerous surgical procedures as well as unnecessary ERCPs in most cases. A tendency toward a lower incidence of conversions and a rarer use of biliary drains may lead to an improved immediate outcome for patients undergoing an LF approach.
机译：背景：关于胆囊胆管结石症的理想治疗尚未达成一致共识。胆囊和胆总管（CBD）结石的治疗目前可以根据两步协议（与腹腔镜胆囊切除术相关的内镜括约肌切开术）或通过一步腹腔镜手术来实现，包括探查CBD和胆囊切除术。内窥镜括约肌切开术据报道具有相当高的发病率/死亡率和CBD结石复发率，而腹腔镜CBD清除术是一项苛刻的程序，迄今为止，这种方法尚未扩展到专门的环境之外。方法：评估我们受胆囊/ CBD结石影响的患者的“腹腔镜检查优先”方法（腹腔镜探查和术中决定是否继续进行腹腔镜CBD探查或将CBD结石治疗推迟至术后内镜逆行胰胆管造影术[ERCP]） ，我们对2000年1月至2004年12月连续49例接受胆囊/ CBD结石治疗的患者的术后结局进行了回顾性，两中心病例对照比较。将这种LF方法获得的结果与传统的LF方法获得的结果进行比较， “内窥镜优先”（EF）方法（ERCP加内窥镜括约肌切开术，然后进行腹腔镜胆囊切除术）。平均随访期为6.4年（范围为4-8年）。结果：完成胆囊切除术和清除CBD所需的早期和晚期并发症，死亡率或开腹手术没有差异。 LF组术后住院时间短。在LF组中，只有22例接受了胆管切开术（45％），而15例接受了围手术期ERCP（30％）。转化次数随实践而减少。胆总管切开术后，越来越多的患者接受了CBD的初次闭合治疗（无胆汁引流），无并发症。结论：LF法治疗胆囊/ CBD结石是安全可行的。在大多数情况下，它可以使大多数外科医生避免过度困难/危险的手术程序以及不必要的ERCP。进行LF入路的患者发生转换的可能性较低，而胆道引流的使用较少，这可能会改善即时结果。

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