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首页> 外文期刊>Surgical Endoscopy >A balanced approach to choledocholithiasis.
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A balanced approach to choledocholithiasis.

机译：胆总管结石的一种平衡治疗方法。

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Background: We set out to review and evaluate the results of an algorithm for managing choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Methods: We performed retrospective review of patients with choledocholithiasis at the time of laparoscopic cholecystectomy (LC) between March 1993 and August 1999. All patients were operated on under the direction of one surgeon (M.E.A), following a consistent algorithm that relies primarily on laparoscopic transcystic common bile duct exploration (TCCBDE) but uses laparoscopic choledochotomy (LCD) when the duct and stones are large or if the ductal anatomy is suboptimal for TCCBDE. Intraoperative endoscopic retrograde sphincterotomy (ERS) is done if sphincterotomy is required to facilitate common bile duct exploration (CBDE). Postoperative endoscopic retrograde cholangiopancreatography (ERCP) is utilized when this fails. Preoperative ERCP is used only for high-risk patients. Results: A total of 728 LC were performed, and there were 60 instances (8.2%) of choledocholithiasis. Primary procedures consisted of 47 TCCBDE; 37 of them required no other treatment. In five cases, the stones were flushed with no exploration. Intraoperative ERS was performed three times as the only form of duct exploration. LCD was utilized twice; one case also required intraoperative ERS, and the other had a postoperative ERCP for stent removal. One patient with small stones was observed, with no sequelae. Preoperative ERCP was done twice as the primary procedure. Of the 10 cases that were not completely cleared by TCCBDE, three had a postoperative ERCP and seven had an intraoperative ERS, one of which required a postoperative ERCP. There were three complications (6%) related to CBDE, with no long-term sequelae. There were four postoperative complications (6.7%) and no deaths. The mean number of procedures per patient was 1.12. The average postoperative hospital stay was 1.8 days (range, 0-14). Conclusions: Choledocholithiasis can be managed safely by laparoscopic techniques, augmenting with ERCP as necessary. This protocol minimizes the number of procedures and decreases the hospital stay.
机译：背景：我们着手审查和评估用于腹腔镜胆囊切除术患者的胆总管结石处理算法的结果。方法：我们对1993年3月至1999年8月在腹腔镜胆囊切除术（LC）时发生胆总管结石症的患者进行了回顾性研究。所有患者均在一名外科医生（MEA）的指导下进行手术，遵循一致的算法，主要依靠腹腔镜经囊性胆总管探查（TCCBDE），但当导管和结石较大或导管解剖学对TCCBDE而言不是最佳时，可使用腹腔镜胆总管切开术（LCD）。如果需要括约肌切开术以促进胆总管探查（CBDE），则需进行术中内镜逆行括约肌切开术（ERS）。如果失败，则采用术后内镜逆行胰胆管造影（ERCP）。术前ERCP仅适用于高危患者。结果：共进行了728例LC，有60例（8.2％）胆总管结石症。主要程序包括47种三氯叔丁醚;其中37例无需其他处理。在五种情况下，没有进行冲洗就将宝石冲洗了。术中ERS作为导管探查的唯一形式进行了三次。 LCD被利用了两次;一例也需要术中ERS，另一例需要术后ERCP进行支架摘除。观察到一名小结石患者，无后遗症。术前ERCP做为主要手术的两次。在TCCBDE未完全清除的10例病例中，有3例术后ERCP，有7例术中ERS，其中1例需要术后ERCP。与三溴二苯醚有关的并发症有3种（6％），无长期后遗症。术后有4例并发症（6.7％）没有死亡。每位患者的平均手术次数为1.12。术后平均住院天数为1.8天（范围0-14）。结论：通过腹腔镜技术可以安全地治疗胆管结石症，必要时可加用ERCP。该方案可最大程度地减少手术次数并减少住院时间。

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