Masci E, Fanti L, Mariani A, Guerini S, Zuliani W, Baccari P, Giacomelli M, Tittobello A
Unit of Gastroenterology and Digestive Endoscopy, University of Milan, IRCCS San Raffaele Hospital Milan, Italy.
Eur J Gastroenterol Hepatol. 1999 Jul;11(7):781-4. doi: 10.1097/00042737-199907000-00017.
Pre-operative endoscopic retrograde cholangiography (ERCP) prior to laparoscopic cholecystectomy (LC) is the most common treatment of gallbladder and common bile duct (CBD) stones. In this study we evaluate our selection criteria for pre-operative ERCP and the results of endoscopic-laparoscopic treatment in patients with CBD stones.
Consecutive adult patients admitted to the department of surgery because of symptomatic cholelithiasis were included in a prospective open trial.
Between January 1996 and December 1996, 841 patients underwent LC at our hospital. ERCP pre-LC was performed in 95 of the 841 patients, on the basis of our selection criteria.
The indication to perform ERCP was suggested by a dilatated CBD (> 10 mm) or ductal stones, abnormal serum liver tests, persisting for more than 3 days, jaundice, cholangitis or pancreatitis. Twelve months after surgery, all patients were contacted by telephone to exclude symptoms related to residual stones.
Cannulation of the CBD was successful in 94 of 95 patients submitted to pre-LC ERCP. CBD stones were found in 87 patients (95.6%) in 22 of whom (25.2%) they were in the form of small stones or sludge. In only three of 94 patients (3.2%) no alterations of the CBD or papilla were found. Complications occurred in eight of 98 patients (in five after endoscopic sphincterotomy (ES), and in three after LC).
Pre-operative ES in selected patients with coexisting gallbladder and CBD stones has been a good approach and the criteria that we used for selection of patients to be submitted to pre-operative ERCP/ES seem to be effective.
腹腔镜胆囊切除术（LC）前的术前内镜逆行胰胆管造影（ERCP）是胆囊和胆总管（CBD）结石最常见的治疗方法。在本研究中，我们评估了术前ERCP的选择标准以及CBD结石患者内镜-腹腔镜联合治疗的结果。
因有症状的胆石症入住外科的连续成年患者被纳入一项前瞻性开放试验。
1996年1月至1996年12月期间，我院841例患者接受了LC。根据我们的选择标准，841例患者中有95例在LC前进行了ERCP。
进行ERCP的指征为CBD扩张（>10mm）或胆管结石、血清肝功能检查异常持续超过3天、黄疸、胆管炎或胰腺炎。术后12个月，通过电话联系所有患者以排除与残留结石相关的症状。
95例接受LC前ERCP的患者中，94例CBD插管成功。87例患者（95.6%）发现有CBD结石，其中22例（25.2%）为小结石或胆泥形式。94例患者中只有3例（3.2%）未发现CBD或乳头有改变。98例患者中有8例发生并发症（内镜下括约肌切开术（ES）后5例，LC后3例）。
对合并胆囊和CBD结石的选定患者进行术前ES是一种很好的方法，我们用于选择接受术前ERCP/ES患者的标准似乎是有效的。
