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首页> 外文期刊>Surgical Endoscopy >The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy.
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The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy.

机译：腹腔镜胆囊切除术期间术中胆管造影阳性的患者的长期随访。

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摘要

BACKGROUND: The routine use of laparoscopic common bile duct exploration (LCBDE) for common bile duct (CBD) stones discovered during cholecystectomy would be further supported if the long-term outcomes were similar to those for endoscopic retrograde cholangiopancreatography with endoscopic papillotomy (ERCP/EP). METHODS: A retrospective review was completed of 151 patients who had a positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC). A "positive" IOC was defined as a filling defect or lack of contrast flow into the duodenum. A successful Long-term follow-up was obtained using a standardized questionnaire to determine the incidence of recurrent biliary pain or need for subsequent ERCP/EP. RESULTS: CBD exploration was attempted in 142 patients (transcystic LCBDE 126 and open CBDE 16) and was successful in 107 of 142 (75%). Transcystic LCBDE was successful in 90 of 126 (71%). ERCP/EP was used in 41 patients; 35 of these cases were for failed LCBDE. Pancreatitis was not observed in any patient after CBDE but was observed in 3 of 41 patients (7.3%) after ERCP/EP. Long-term follow-up of the LCBDE versus ERCP/EP patients revealed no difference in the incidence of recurrent biliary pain or need for subsequent ERCP (mean follow-up time of 61 months). CONCLUSION: LCBDE is safe and effective in the majority of cases when an attempt at transcystic LCBDE was made. In addition, after long-term follow-up of >5 years, the outcomes were similar if the stones were removed by intraoperative laparoscopic methods versus postoperative ERCP. LCBDE seems worthy of pursuing when an intraoperative CBD stone is discovered.
机译：背景：如果长期结局类似于内镜逆行胰胆管切除术（ERCP / EP），长期应用胆囊切除术发现的胆总管结石（CBD），则常规使用腹腔镜胆总管探查术（LCBDE） ）。方法：回顾性分析了151例腹腔镜胆囊切除术（LC）期间术中胆管造影（IOC）阳性的患者。 “阳性” IOC定义为充盈缺损或缺乏进入十二指肠的造影剂。使用标准化的调查表成功进行了长期随访，以确定复发性胆道疼痛的发生率或是否需要后续的ERCP / EP。结果：尝试了142例患者的CBD探索（经囊性LCBDE 126和开放性CBDE 16），并且在142例患者中有107例成功（75％）。经囊性LCBDE在126例中有90例成功（71％）。 ERCP / EP用于41例患者。这些案例中有35个是针对LCBDE失败的案例。 CBDE后未在任何患者中观察到胰腺炎，但ERCP / EP后41例患者中有3例（7.3％）观察到胰腺炎。 LCBDE与ERCP / EP患者的长期随访表明，复发性胆道疼痛的发生率或随后的ERCP的发生率无差异（平均随访时间为61个月）。结论：在尝试经囊性LCBDE的大多数情况下，LCBDE是安全有效的。此外，经过5年以上的长期随访后，与术中ERCP相比，如果通过术中腹腔镜方法切除结石，其结果相似。当发现术中CBD结石时，LCBDE似乎值得追求。

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