Filauro M, Comes P, De Conca V, Coccia G, Prandi M, Bagarolo C, Marini P, Anfossi A
I UO Chirurgia Generale, Ospedali Galliera, Genova, Italy.
Hepatogastroenterology. 2000 Jul-Aug;47(34):922-6.
BACKGROUND/AIMS: The treatment of common bile duct stones diagnosed during videolaparoscopic cholecystectomy is still under debate. In cases of suspected common bile duct stones, a double approach with endoscopic retrograde cholangiopancreatography either prior to, or following videolaparoscopic cholecystectomy is the current routine in many centers. An intraoperative endoscopic retrograde cholangiopancreatography with endoscopic papillosphincterotomy and stone extraction has recently been proposed.
We compared the approaches for suspected common bile duct stones in 21 cases of combined intervention endoscopic retrograde cholangiopancreatography during videolaparoscopic cholecystectomy to 17 cases of sequential intervention (endoscopic retrograde cholangiopancreatography prior to videolaparoscopic cholecystectomy). Complications and postoperative monitoring are discussed and reported on the basis of hospital stay.
Although the efficacy and the complications are similar, patients treated with the sequential approach stayed in the hospital longer because of the double monitoring period during both after endoscopic retrograde cholangiopancreatography and after videolaparoscopic cholecystectomy.
A combined approach to suspected common bile duct stones during videolaparoscopic cholecystectomy could be an effective and a financially worthwhile treatment.
背景/目的：在视频腹腔镜胆囊切除术期间诊断出的胆总管结石的治疗仍存在争议。在怀疑有胆总管结石的情况下，在视频腹腔镜胆囊切除术之前或之后采用内镜逆行胰胆管造影的双重方法是许多中心目前的常规做法。最近有人提出在术中进行内镜逆行胰胆管造影并进行内镜乳头括约肌切开术和取石。
我们比较了21例在视频腹腔镜胆囊切除术期间联合进行内镜逆行胰胆管造影的疑似胆总管结石的治疗方法与17例序贯干预（在视频腹腔镜胆囊切除术之前进行内镜逆行胰胆管造影）的方法。根据住院时间对并发症和术后监测进行了讨论和报告。
尽管疗效和并发症相似，但采用序贯方法治疗的患者住院时间更长，因为在内镜逆行胰胆管造影后和视频腹腔镜胆囊切除术后都有双重监测期。
在视频腹腔镜胆囊切除术期间对疑似胆总管结石采用联合方法可能是一种有效且经济上值得的治疗方法。
