13年腹腔镜经胆囊管胆总管探查取石经验：有效性及长期结果
Thirteen years' experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results.
作者信息
Paganini A M, Guerrieri M, Sarnari J, De Sanctis A, D'Ambrosio G, Lezoche G, Perretta S, Lezoche E
机构信息
Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Via Conca, 60020, Ancona, Italy.
出版信息
Surg Endosc. 2007 Jan;21(1):34-40. doi: 10.1007/s00464-005-0286-3. Epub 2006 Nov 16.
BACKGROUND
The aim of the present study was to evaluate the effectiveness and long-term results of laparoscopic transcystic common bile duct exploration (TC-CBDE).
METHODS
Ductal stones were present in 344 of 3212 patients (10.7%) who underwent laparoscopic cholecystectomy (LC). The procedure was completed laparoscopically in 329 patients (95.6%), with TC-CBDE performed in 191 patients (58.1%) who are the object of this study, or with a transverse choledochotomy in 138 cases (41.9%).
RESULTS
Biliary drainage was employed in 71 of 191 cases (37.2%). Major complications occurred in 10 patients (5.1%), including retained stones in 6 (3.1%). Mortality was nil. No patients were lost to follow-up (median: 118.0 months; range: 17.6-168 months). No signs of bile stasis, no recurrent ductal stones and no biliary stricture were observed. At present 182 patients are alive with no biliary symptoms; 9 have died from unrelated causes.
CONCLUSIONS
Long-term follow-up after laparoscopic TC-CBDE proved its effectiveness and safety for single-stage management of gallstones and common bile duct stones.
背景
本研究的目的是评估腹腔镜经胆囊管胆总管探查术（TC-CBDE）的有效性和长期结果。
方法
在3212例行腹腔镜胆囊切除术（LC）的患者中，344例（10.7%）存在胆管结石。329例（95.6%）患者通过腹腔镜完成手术，其中191例（58.1%）患者接受了TC-CBDE（本研究的对象），138例（41.9%）患者行胆总管横切术。
结果
191例患者中有71例（37.2%）采用了胆道引流。10例患者（5.1%）发生了主要并发症，其中6例（3.1%）为残留结石。无死亡病例。无失访患者（中位随访时间：118.0个月；范围：17.6 - 168个月）。未观察到胆汁淤积迹象、复发性胆管结石和胆道狭窄。目前，182例患者存活且无胆道症状；9例死于无关原因。
结论
腹腔镜TC-CBDE术后的长期随访证明了其在单阶段治疗胆囊结石和胆总管结石方面的有效性和安全性。
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