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首页> 外文期刊>Surgical Endoscopy >Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital.
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Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital.

机译：术中ERCP的单阶段治疗：在西班牙一家非三级医院中就诊可能存在胆总管结石和胆囊的患者。

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The best way to reduce endoscopic retrograde cholangiopancreatography (ERCP) complications is not to perform it if it is unnecessary. Both intraoperative and postoperative ERCP rely on use of intraoperative cholangiography as a final diagnostic test for choledocholithiasis (CLD) whenever clinical data are unable to rule out CLD. Intraoperative ERCP could become a therapeutic option when a previous preoperative ERCP fails. We present our experience with intraoperative ERCP.This is a descriptive and prospective study of a cohort of 82 patients with moderate risk of CLD. They were operated on by laparoscopic cholecystectomy with intraoperative cholangiography (IOC). We performed intraoperative ERCP using the rendezvous technique.Thirty-six out of 82 patients had an abnormal IOC study. Mean age was 58.7 years (standard deviation, SD 16.6, 25-83 years), and 60.6% were females. Ultrasound study showed that 51.4% of patients had a dilated bile duct. Magnetic resonance cholangiography (MRC) was performed on three patients (8.3%). The success rate of intraoperative ERCP was 88.2%. Three out of the 36 patients (8.8%) had ERCP complications [2 mild papillary bleeding (5.8%), 1 acute pancreatitis (2.9%)]. The rate of conversion to open surgery was 5% with a surgical complications rate of 4% [one injured duct and two surgical bleeding which required re-operation (2.5%)]. There were no mortalities. Four patients (11.1%) needed post-surgical ERCP, with a residual CLD rate of 5.6% (two patients) in the postoperative period. Mean surgical time was 181 min (SD 60, 75-345 min). Mean hospital stay was 6.2 days (SD 4.7, 2-24 days).Intraoperative ERCP is an option to prevent performing ERCP unnecessarily on patients with moderate risk of CLD not confirmed using appropriate radiological studies. It can resolve the biliary disease in a single step with a similar success rate to standard ERCP, but with low morbidity, especially of acute pancreatitis. The residual CLD rate is also very low.
机译：减少内窥镜逆行胰胆管造影术（ERCP）并发症的最好方法是在不必要的情况下不进行手术。每当临床数据不能排除CLD时，术中和术后ERCP都依赖于术中胆管造影术作为胆总管结石症（CLD）的最终诊断测试。当先前的术前ERCP失败时，术中ERCP可能成为治疗选择。我们介绍了术中ERCP的经验，这是对82名中度CLD风险患者的描述性和前瞻性研究。他们通过腹腔镜胆囊切除术和术中胆管造影术（IOC）进行手术。我们使用会合技术进行了术中ERCP.82例患者中有36例IOC研究异常。平均年龄为58.7岁（标准差，SD为16.6，25-83岁），女性为60.6％。超声研究显示51.4％的患者胆管扩张。对三名患者（8.3％）进行了磁共振胆管造影（MRC）。术中ERCP成功率为88.2％。 36例患者中有3例（8.8％）患有ERCP并发症[2例轻度乳头出血（5.8％），1例急性胰腺炎（2.9％）]。开腹手术的转化率为5％，手术并发症率为4％[一根受伤的导管和两次需要再次手术的手术出血（2.5％）]。没有死亡。术后需要ERCP的患者有四名（11.1％），术后CLD残留率为5.6％（两名患者）。平均手术时间为181分钟（标准差60，75-345分钟）。平均住院天数为6.2天（SD 4.7，2-24天）。术中ERCP是一种预防措施，可以防止对未经适当放射学检查证实为中度CLD风险的患者不必要地进行ERCP。它可以一步解决胆道疾病，成功率与标准ERCP相似，但发病率低，尤其是急性胰腺炎。残留的CLD率也非常低。

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