Department of General Surgery, The Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH, UK.
Surg Endosc. 2011 Jul;25(7):2105-16. doi: 10.1007/s00464-010-1544-6. Epub 2011 Feb 7.
The laparoscopic approach for biliary bypass surgery is a contemporary management option. This article reviews the evidence available for its role and effectiveness.
A computerised search was made of the MEDLINE, PubMed, and EMBASE databases for English language publications from the first report of laparoscopic biliary bypass in 1992 to January 2010.
Some 89 patients featured in 19 reports underwent 89 laparoscopic biliary bypass procedures for benign (n=17) and malignant (n=72) indications. Of those, 52 patients underwent biliary bypass alone, while 37 patients underwent biliary bypass combined with gastric bypass. The procedures included cholecystojejunostomy (n=64), hepaticojejunostomy (n=14), and choledochoduodenostomy (n=11). The overall success rate in achieving resolution of jaundice was 98.9%, with a morbidity rate of 12.3% and a mortality rate of 5.6%. More than one procedure was required in 1.1% of patients to achieve resolution of obstructive jaundice. During a reported median follow-up period of 13 months, obstructive jaundice recurred in none of the patients.
The laparoscopic approach to biliary bypass surgery is safe and has a high initial success rate, low reintervention rate, and low morbidity and mortality rates. Longer follow-up data and comparative studies with open surgery and endoscopic stenting are needed.
腹腔镜胆道旁路手术是一种当代的治疗选择。本文回顾了其作用和有效性的相关证据。
计算机检索 MEDLINE、PubMed 和 EMBASE 数据库，检索时间从 1992 年首例腹腔镜胆道旁路手术报道开始至 2010 年 1 月，检索语言为英文。
19 项研究共纳入 89 例患者，19 例患者共接受了 89 例腹腔镜胆道旁路手术，用于治疗良性（n=17）和恶性（n=72）疾病。其中，52 例行单纯胆道旁路手术，37 例行胆道旁路联合胃旁路手术。手术方式包括胆囊空肠吻合术（n=64）、肝肠吻合术（n=14）和胆肠吻合术（n=11）。总体上，解除黄疸的成功率为 98.9%，并发症发生率为 12.3%，死亡率为 5.6%。有 1.1%的患者需要进行多次手术才能解除梗阻性黄疸。在报道的 13 个月的中位随访期内，无患者发生复发性阻塞性黄疸。
腹腔镜胆道旁路手术是安全的，具有较高的初始成功率、较低的再干预率、较低的并发症发生率和死亡率。还需要更长的随访数据和与开腹手术及内镜支架置入术的比较研究。
