La Greca Gaetano, Barbagallo Francesco, Di Blasi Michele, Di Stefano Manuela, Castello Giorgio, Gagliardo Salvina, Latteri Saverio, Russello Domenico
Department of Surgical Sciences, Transplantation, and Advanced Technologies, Cannizzaro Hospital, University of Catania, Catania, Italy.
J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):167-71. doi: 10.1089/lap.2006.0030.
Endoscopic procedures on Vater's papilla are related to pancreatic damage with or without pathologic increase of pancreatic enzymes. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is a standard treatment for common bile duct stones, performed sequentially before or after laparoscopic cholecystectomy. The "rendezvous" (RV) procedure combines laparoscopic cholecystectomy, intra-operative cholangiography, and endoscopic bile duct clearance and is an alternative to the sequential treatment. We tried to analyze relevant differences between the two options concerning the main parameters of pancreatic damage.
Thirty-eight patients treated for biliary stones were divided into two groups of 19 patients depending on the type of treatment (RV vs. ERCP) and were compared for post-procedural amylase and lipase levels; the duration of the endoscopic procedures, effectiveness, and complications were also recorded.
A pathologic increase of serum amylase occurred in 15.7% of the RV group and 47.3% of the ERCP group with significant differences regarding amylase levels in the 6- and 66-hour samples (p < 0.003; p < 0.006). The mean duration of endoscopic procedure was significantly shorter in the RV group (17 vs. 26 minutes, p < 0.0001). RV was effective in common bile duct clearance in 100% of cases, while ERCP was effective in only 89.5%. Minor morbidity affected one patient in each group.
This is the first report comparing combined laparoendoscopic RV versus ERCP for potential pancreatic damage and showing that RV reduces the number of patients with an iatrogenic pathologic increase of amylase when compared to ERCP, and also significantly reduces the duration of endoscopic procedure.
对十二指肠乳头进行内镜操作与胰腺损伤有关，无论胰腺酶是否有病理升高。内镜逆行胰胆管造影术（ERCP）联合内镜括约肌切开术是胆总管结石的标准治疗方法，可在腹腔镜胆囊切除术之前或之后依次进行。“会师”（RV）手术结合了腹腔镜胆囊切除术、术中胆管造影和内镜胆管清理，是序贯治疗的一种替代方法。我们试图分析这两种治疗方案在胰腺损伤主要参数方面的相关差异。
38例接受胆石症治疗的患者根据治疗类型（RV与ERCP）分为两组，每组19例，比较术后淀粉酶和脂肪酶水平；记录内镜操作的持续时间、有效性和并发症。
RV组15.7%的患者血清淀粉酶出现病理性升高，ERCP组为47.3%，在6小时和66小时样本的淀粉酶水平上存在显著差异（p<0.003；p<0.006）。RV组内镜操作的平均持续时间明显更短（17分钟对26分钟，p<0.0001）。RV在100%的病例中对胆总管清理有效，而ERCP仅在89.5%的病例中有效。每组各有1例患者出现轻微并发症。
这是第一篇比较腹腔镜内镜联合RV与ERCP潜在胰腺损伤的报告，表明与ERCP相比，RV可减少医源性淀粉酶病理性升高的患者数量，并且还显著缩短了内镜操作的持续时间。
