Güitrón-Cantú Alfredo, Adalid-Martínez Raúl, Gutiérrez-Bermúdez José A
Departamento de Endoscopia Digestiva, Hospital de Especialidades No. 71 IMSS, Blvd. Revolución y Calle 26, 27000 Torreón, Coah.
Rev Gastroenterol Mex. 2002 Jul-Sep;67(3):166-70.
The unexpected detection of stones in common bile duct during laparoscopic cholecystectomy is a concern for laparoscopic surgeons. Immediate laparoscopic removal may not always be feasible due to inadequate operating facilities, surgeons, and assistants. Attempts have been made to identify clinical and biochemical predictor of common bile duct stones, the results of which have not been consistent.
The aim of this study was to define patients with risk for common bile duct stones based on history, abdominal ultrasound, and biochemical derangements, as well as to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) for diagnosis and duct clearance if necessary.
This is a prospective cross sectional analysis of 82 patients (66 females and 16 males) with gallstones on whom were performed clinical examination, laboratory test, and abdominal ultrasound to identify predictors of common bile duct stones. Preoperative ERCP was carried out and patients underwent ES for stone retrieval.
Clinical evidence of jaundice or pancreatitis, elevated serum amylase, and ultrasonographic evidence of biliary tree dilation or common bile duct stone were considered risk factors. In 45 patients, common bile duct stones were identified at preoperative ERCP patients underwent ES, and stones were removed with 100% success. All patients were scheduled for laparoscopic cholecystectomy 24 h later. There was no mortality in this series.
Clinical evidence of jaundice or pancreatitis, elevation of serum amylase and dilated common bile duct or presence of common bile duct stones were considered risk factors for choledocholithiasis. Use of such a model rather than individual criteria would improve selection of patients for preoperative ERCP, optimizing its role in the laparoscopic era.
腹腔镜胆囊切除术期间意外发现胆总管结石是腹腔镜外科医生关注的问题。由于手术设备、外科医生和助手不足，立即进行腹腔镜取石并不总是可行的。人们曾试图确定胆总管结石的临床和生化预测指标，但其结果并不一致。
本研究的目的是根据病史、腹部超声和生化紊乱来确定有胆总管结石风险的患者，并评估内镜逆行胰胆管造影（ERCP）和内镜括约肌切开术（ES）在必要时用于诊断和清除胆管结石的作用。
这是一项对82例胆结石患者（66例女性和16例男性）进行的前瞻性横断面分析，对这些患者进行了临床检查、实验室检查和腹部超声检查，以确定胆总管结石的预测指标。术前进行了ERCP，并对患者进行了ES取石。
黄疸或胰腺炎的临床证据、血清淀粉酶升高以及胆道扩张或胆总管结石的超声证据被视为危险因素。在45例患者中，术前ERCP时发现胆总管结石，这些患者接受了ES，结石清除成功率为100%。所有患者在24小时后安排进行腹腔镜胆囊切除术。本系列无死亡病例。
黄疸或胰腺炎的临床证据、血清淀粉酶升高以及胆总管扩张或胆总管结石存在被视为胆总管结石的危险因素。使用这样的模型而非个别标准将改善术前ERCP患者的选择，优化其在腹腔镜时代的作用。
