Pierce Richard A, Jonnalagadda Sreenivasa, Spitler Jennifer A, Tessier Deron J, Liaw Jane M, Lall Shelly C, Melman Lora M, Frisella Margaret M, Todt Laura M, Brunt L Michael, Halpin Valerie J, Eagon J Christopher, Edmundowicz Steven A, Matthews Brent D
Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, Saint Louis, MO 63110, USA.
Surg Endosc. 2008 Nov;22(11):2365-72. doi: 10.1007/s00464-008-9785-3. Epub 2008 Mar 6.
The purpose of this study is to determine the incidence of residual common bile duct (CBD) stones after preoperative ERCP for choledocholithiasis and to evaluate the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) in this patient population.
All patients who underwent preoperative ERCP and interval LC with IOC from 5/96 to 12/05 were reviewed under an Institutional Review Board (IRB)-approved protocol. Data collected included all radiologic imaging, laboratory values, clinical and pathologic diagnoses, and results of preoperative ERCP and LC with IOC. Standard statistical analyses were used with significance set at p < 0.05.
A total of 227 patients (male:female 72:155, mean age 51.9 years) underwent preoperative ERCP for suspicion of choledocholithiasis. One hundred and eighteen patients were found to have CBD stones on preoperative ERCP, and of these, 22 had choledocholithiasis diagnosed on IOC during LC. However, two patients had residual stones on completion cholangiogram after ERCP and were considered to have retained stones. Therefore, 20 patients overall were diagnosed with either interval passage of stones into the CBD or a false-negative preoperative ERCP. In the 109 patients without CBD stones on preoperative ERCP, nine patients had CBD stones on IOC during LC, an 8.3% incidence of interval passage of stones or false-negative preoperative ERCP. In both groups, there was no correlation (p > 0.05) between an increased incidence of CBD stones on IOC and a longer time interval between ERCP and LC, performance of sphincterotomy, incidence of cystic duct stones, or pathologic diagnosis of cholelithiasis.
The overall incidence of retained or newly passed CBD stones on IOC during LC after a preoperative ERCP is 12.9%. Although the natural history of residual CBD stones after preoperative ERCP is not known, the routine use of IOC should be considered in patients with CBD stones on preoperative ERCP undergoing an interval LC.
本研究的目的是确定术前内镜逆行胰胆管造影（ERCP）治疗胆总管结石后残余胆总管（CBD）结石的发生率，并评估在该患者群体中腹腔镜胆囊切除术（LC）期间常规术中胆管造影（IOC）的效用。
对1996年5月至2005年12月期间接受术前ERCP及间隔期LC并进行IOC的所有患者，按照机构审查委员会（IRB）批准的方案进行回顾性研究。收集的数据包括所有放射影像学检查、实验室值、临床和病理诊断以及术前ERCP和LC联合IOC的结果。采用标准统计学分析，显著性设定为p < 0.05。
共有227例患者（男:女为72:155，平均年龄51.9岁）因怀疑胆总管结石接受了术前ERCP。术前ERCP发现118例患者有CBD结石，其中22例在LC期间通过IOC诊断为胆总管结石。然而，2例患者在ERCP后的完成胆管造影时有残余结石，被认为有结石残留。因此，总体上有20例患者被诊断为结石间歇性进入CBD或术前ERCP假阴性。在术前ERCP未发现CBD结石的109例患者中，9例在LC期间通过IOC发现有CBD结石，结石间歇性通过或术前ERCP假阴性的发生率为8.3%。在两组中，IOC上CBD结石发生率增加与ERCP和LC之间的时间间隔延长、括约肌切开术的实施、胆囊管结石的发生率或胆石症的病理诊断之间均无相关性（p > 0.05）。
术前ERCP后LC期间IOC上残留或新出现的CBD结石的总体发生率为12.9%。虽然术前ERCP后残余CBD结石的自然病程尚不清楚，但对于术前ERCP发现有CBD结石且接受间隔期LC的患者，应考虑常规使用IOC。
