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胆囊结石合并胆总管结石患者在内镜逆行胰胆管造影术后进行腹腔镜胆囊切除术的时机。

The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis.

作者信息

Salman Bulent, Yilmaz Utku, Kerem Mustafa, Bedirli Abdulkadir, Sare Mustafa, Sakrak Omer, Tatlicioglu Ertan

机构信息

Department of General Surgery, Gazi University Medical School, Beşevler, 06500, Ankara, Turkey.

出版信息

J Hepatobiliary Pancreat Surg. 2009;16(6):832-6. doi: 10.1007/s00534-009-0169-4. Epub 2009 Aug 22.

DOI:10.1007/s00534-009-0169-4
PMID:19701600
Abstract

BACKGROUND

An accepted treatment strategy for cholelithiasis with secondary choledocholithiasis is the laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreaticography (ERCP). Although early cholecystectomy is advised, there is no consensus about the time interval between LC and ERCP. The aim of this study is to evaluate the effects of the time interval between ERCP and ERCP on operation outcomes.

METHODS

Patients with cholelithiasis and a risk of choledocholithiasis underwent ERCP. Patients were grouped as those operated on between 24 and 72 h after ERCP (group 1) and those operated on more than 72 h after ERCP (group 2). Patients' age, gender, body mass index, American Society of Anesthesiologists Physical Status, abdominal ultrasonography findings, white blood cell count, total serum bilirubin, ALP, amylase, ALT, AST, GGT levels, ERCP findings, time interval between ERCP and LC, conversion rate, median postoperative hospital stay, median operation time, intraoperative complication and postoperative complication rates were collected.

RESULTS

There was no significant difference between the demographics of the patients in both groups. The median operation time, median postoperative hospital stay and conversion rate in group 2 were significantly higher than those of group 1. More postoperative complications were seen in group 2.

CONCLUSION

Early cholecystectomy after ERCP, within 72 h, has better outcomes, probably due to the inflammatory processes.

摘要

背景

对于合并继发性胆总管结石的胆囊结石,公认的治疗策略是在经内镜逆行胰胆管造影术(ERCP)后行腹腔镜胆囊切除术(LC)。尽管建议早期行胆囊切除术,但对于LC与ERCP之间的时间间隔尚无共识。本研究的目的是评估ERCP与LC之间的时间间隔对手术结果的影响。

方法

对有胆囊结石且有胆总管结石风险的患者进行ERCP。患者分为两组,一组在ERCP后24至72小时内接受手术(第1组),另一组在ERCP后72小时以上接受手术(第2组)。收集患者的年龄、性别、体重指数、美国麻醉医师协会身体状况分级、腹部超声检查结果、白细胞计数、血清总胆红素、碱性磷酸酶、淀粉酶、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转移酶水平、ERCP检查结果、ERCP与LC之间的时间间隔、中转率、术后住院时间中位数、手术时间中位数、术中并发症及术后并发症发生率。

结果

两组患者的人口统计学特征无显著差异。第2组的手术时间中位数、术后住院时间中位数和中转率均显著高于第1组。第2组术后并发症更多。

结论

ERCP后72小时内行早期胆囊切除术效果更好,可能是由于炎症过程所致。

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