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首页> 外文期刊>Surgical Endoscopy >Laparoscopic transcystic exploration for single-stage management of common duct stones and acute cholecystitis.
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Laparoscopic transcystic exploration for single-stage management of common duct stones and acute cholecystitis.

机译：腹腔镜经胆囊探查术对胆总管结石和急性胆囊炎的单阶段治疗。

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BACKGROUND: Common bile duct (CBD) stones are found in 10% of patients who undergo elective laparoscopic surgery for gallstone disease and in 10-20% of patients who present with acute cholecystitis (AC). For the latter, the role of laparoscopic transcystic exploration of the common duct (LTCE) as part of a single-stage procedure is still unknown. METHODS: This study, based on a laparoscopy first cholecystocholedocholithiasis: 104 underwent a scheduled laparoscopic surgery (group A), and 97 where admitted for AC and had urgent laparoscopy (group B). Group B patients were significantly older (68.4 vs. 62.1 years; P = 0.0045), had a higher proportion of women (56% vs. 41%; P = 0.0345), and included more patients in the ASA III-IV class (39% vs. 21%; P = 0.0006). LTCE was performed by using basket-wired catheters. CBD clearance, operating time, conversion rate, morbidity and mortality, postoperative hospital stay, readmission, and residual CBD stones were the main outcome measures. RESULTS: Clearance of CBD was obtained in 84% of patients of group A and in 80% of patients of group B (P = not significant). Time spent in the operating room was longer for group B (175 vs. 141 min; P = 0.0003). There were no significant differences for postoperative hospital stay (group A 4.9 vs. group B 5.2 days), readmission rate (3.7% vs. 3.7%), and residual CBD stones (2.8% vs. 3.1%). Need to convert and morbidity occurred more frequently in group B (11.7% vs. 4.6% and 28.7% vs. 16.8%, respectively), but differences were not significant. In group A, one patient died from MOFS. CONCLUSIONS: LTCE has proved to be a simple technique with a high yield of CBD clearance in the acute setting. Courses are comparable to those observed for the same procedure in elective surgery despite the fact that patients with AC are more at risk for drawbacks.
机译：背景：胆囊疾病的选择性腹腔镜手术患者中有10％发现胆总管结石，急性胆囊炎（AC）患者中有10-20％发现胆总管结石。对于后者，作为单阶段手术的一部分，腹腔镜经胆总管探查术的作用仍是未知的。方法：本研究基于腹腔镜首次胆囊胆管结石症：104例行了腹腔镜手术（A组），97例接受了AC手术并进行了紧急腹腔镜检查（B组）。 B组患者年龄较大（68.4岁对62.1岁; P = 0.0045），女性比例更高（56％对41％; P = 0.0345），并且包括更多的ASA III-IV级患者（39） ％与21％; P = 0.0006）。 LTCE通过使用篮筐式导管进行。 CBD清除率，手术时间，转换率，发病率和死亡率，术后住院时间，再入院率和残留的CBD结石是主要的结局指标。结果：A组84％的患者和B组80％的患者获得了CBD清除率（P =不显着）。 B组在手术室中花费的时间更长（175对141分钟; P = 0.0003）。术后住院时间（A组4.9天与B组5.2天），再入院率（3.7％对3.7％）和残留CBD结石（2.8％对3.1％）无显着差异。 B组需要转换和发病的频率更高（分别为11.7％对4.6％和28.7％对16.8％），但差异不显着。在A组中，一名患者死于MOFS。结论：LTCE已被证明是一种简单的技术，在急性环境中CBD清除率很高。尽管与AC患者相比，AC的患病风险更高，但其课程与在选择性手术中相同手术所观察到的课程相当。

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