Li M K W, Tang C N, Lai E C H
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
Asian J Endosc Surg. 2011 May;4(2):53-8. doi: 10.1111/j.1758-5910.2011.00073.x. Epub 2011 Mar 17.
There is still no consensus on the ideal management of common bile duct (CBD) stones. This article aims to review the management of concomitant gallbladder stones and CBD stones in the laparoscopic era.
A PubMed database search was performed to identify MEDLINE articles from 1986 to 2010 using the key terms "common bile duct stones,""cholecystectomy,""bile duct exploration,""ERCP" (endoscopic retrograde cholangiography), and "endoscopic sphincterotomy."
There were five randomized comparative trials (RCT) comparing sequential preoperative ERCP and laparoscopic cholecystectomy (LC) to laparoscopic common bile duct exploration (LCBDE). Two RCTs showed similar stone clearance rates and shorter hospital stays in the LCBDE group, while three RCTs showed similar stone clearance rates and hospital stays in sequential preoperative ERCP, LC and LCBDE groups. There were two RCTs comparing LCBDE to sequential LC and postoperative ERCP. One showed similar stone clearance rate and shorter hospital stay in LCBDE group, while the other showed similar stone clearance rate and hospital stay. There were three RCTs comparing sequential preoperative ERCP and LC against LC with intraoperative ERCP. All three studies showed similar stone clearance rates and shorter hospital stays in the intraoperative ERCP group. There was only one RCT comparing sequential preoperative ERCP and LC against sequential LC and postoperative ERCP. This showed a similar stone clearance rate and shorter hospital stay in the postoperative ERCP group.
Different management approaches of concomitant gallbladder stones and CBD stones were equivalent in efficacy. However, one-stage management had the advantage of providing a shorter hospital stay.
对于胆总管结石的理想治疗方法仍未达成共识。本文旨在回顾腹腔镜时代胆囊结石合并胆总管结石的治疗方法。
通过在PubMed数据库中检索，使用关键词“胆总管结石”“胆囊切除术”“胆管探查术”“内镜逆行胰胆管造影术（ERCP）”和“内镜括约肌切开术”，以识别1986年至2010年的MEDLINE文章。
有五项随机对照试验（RCT）比较了术前序贯ERCP和腹腔镜胆囊切除术（LC）与腹腔镜胆总管探查术（LCBDE）。两项RCT显示LCBDE组结石清除率相似且住院时间更短，而三项RCT显示术前序贯ERCP、LC和LCBDE组结石清除率和住院时间相似。有两项RCT比较了LCBDE与序贯LC及术后ERCP。一项显示LCBDE组结石清除率相似且住院时间更短，而另一项显示结石清除率和住院时间相似。有三项RCT比较了术前序贯ERCP和LC与术中ERCP的LC。所有三项研究均显示术中ERCP组结石清除率相似且住院时间更短。仅有一项RCT比较了术前序贯ERCP和LC与序贯LC及术后ERCP。这显示术后ERCP组结石清除率相似且住院时间更短。
胆囊结石合并胆总管结石的不同治疗方法疗效相当。然而，一期治疗具有缩短住院时间的优势。
