Gholipour Changiz, Shalchi Rosita A, Abassi Mehrshad
Department of General Surgery, Sinaea Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):634-8. doi: 10.1089/lap.2006.0199.
The elective laparoscopic management of common bile duct (CBD) stones is widely accepted; however, the urgent laparoscopic exploration of common bile duct (LCBDE) within the first 72 hours of acute cholangitis is not assessed extensively. Our aim was to study the safety and efficacy of urgent LCBDE in patients with acute cholangitis.
In a single-center prospective study, 73 patients of a university hospital with acute gallstone cholangitis were operated on with laparoscopy or open surgery, based on a predetermined schedule concerning the presence of the skilled laparoscopic surgeon at the hospital. Patients with sever acute cholangitis (e.g., organ failure, shock, or peritonitis), pancreatitis, and suspected tumoral obstructions were excluded. The major outcomes, including mortality, complications of surgery, and the length of hospital and intensive care unit (ICU) stay, are reported in this paper.
In all 36 open surgery patients, a choledocotomy and T-tube placement procedure were performed. In laparoscopic patients, CBD clearance was approached by a transcystic and choledocotomy approach in 15 and 22 subjects, respectively. Eight (6 in the open and 2 in the laparoscopic group) choledocoduodenostomies were performed. Cholangitis was controlled sufficiently in all patients. Of 37 laparoscopies, 3 operations were converted into open surgeries. Operation time was longer in the laparoscopic group, compared to the open group (201 +/- 15 vs. 146 +/- 6.1 minutes; P < 0.01). The average ICU and hospital stay after an operation were significantly less than open surgery group. Total cost of treatment in laparoscopic group was less than 75% of that of the open surgery group. General complications were more common in the open surgery group. There was no mortality. One retained stone was discovered in the laparoscopic group.
Early one-stage LCBDE is an effective procedure as an initial and definite management of acute gallstone cholangitis, which prevents a second hospitalization and relapse problems.
选择性腹腔镜治疗胆总管（CBD）结石已被广泛接受；然而，急性胆管炎发病72小时内进行急诊腹腔镜胆总管探查术（LCBDE）尚未得到广泛评估。我们的目的是研究急诊LCBDE治疗急性胆管炎患者的安全性和有效性。
在一项单中心前瞻性研究中，一家大学医院的73例急性胆石性胆管炎患者根据医院熟练腹腔镜外科医生的排班情况，接受了腹腔镜手术或开放手术。排除患有严重急性胆管炎（如器官衰竭、休克或腹膜炎）、胰腺炎以及疑似肿瘤性梗阻的患者。本文报告了主要结局，包括死亡率、手术并发症以及住院时间和重症监护病房（ICU）住院时间。
所有36例接受开放手术的患者均进行了胆总管切开术和T管置入术。在腹腔镜手术患者中，分别有15例和22例通过经胆囊和胆总管切开途径清除胆总管结石。进行了8例胆总管十二指肠吻合术（开放组6例，腹腔镜组2例）。所有患者的胆管炎均得到充分控制。37例腹腔镜手术中有3例转为开放手术。与开放组相比，腹腔镜组的手术时间更长（201±15分钟对146±6.1分钟；P<0.01）。术后平均ICU住院时间和住院时间明显短于开放手术组。腹腔镜组的总治疗费用不到开放手术组的75%。开放手术组的一般并发症更为常见。无死亡病例。腹腔镜组发现1例残留结石。
早期一期LCBDE是治疗急性胆石性胆管炎的有效初始确定性方法，可避免二次住院和复发问题。
