Hoyuela C, Cugat E, Bretcha P, Collera P, Espinós J, Marco C
Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mútua de Terrassa Hospital, Terrassa, and University of Barcelona, Spain.
Dig Surg. 1999;16(5):411-4. doi: 10.1159/000018757.
To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC).
A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data.
ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP.
A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.
评估术前内镜逆行胰胆管造影术（ERCP）在诊断和治疗腹腔镜胆囊切除术（LC）前疑似胆管结石患者中的效果。
对1991年至1997年间连续进行的1235例LC手术进行前瞻性研究。当根据临床、分析或超声检查数据怀疑有胆总管结石时，术前进行ERCP以探查胆总管（CBD）。
268例患者进行了ERCP：3%的患者胆总管评估未成功；13%的患者胆总管扩张但无结石，37%（99例患者）的探查结果正常。46%（124例患者）发现了胆总管结石，随后进行了内镜括约肌切开术并尝试取石。内镜治疗成功取出胆总管结石的比例为92.8%（115例患者）。无ERCP相关死亡，发病率为6%。ERCP-LC术后7例患者发现有残留胆总管结石；所有患者均通过ERCP成功治疗。
选择性使用ERCP联合LC治疗胆管结石是一种较好的治疗选择。然而，ERCP通常的选择标准可能导致不必要的探查。似乎有必要修改当前的诊断和治疗策略。
