Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockhom, Sweden.
Surg Endosc. 2013 Jul;27(7):2498-503. doi: 10.1007/s00464-012-2768-4. Epub 2013 Jan 26.
Rendezvous intraoperative endoscopic retrograde cholangiography (RV-IOERC), also called guidewire-facilitated IOERC, is one of the single-stage options available for managing common bile duct stones (CBDS) during laparoscopic cholecystectomy. The objective of this study is to investigate procedure-related complications in IOERC patients and stone clearance.
All patients who underwent IOERC between January 2000 and December 2009 were identified from the local registry of Karolinska University Hospital in Huddinge. Medical charts and ERC reports were studied, and descriptive statistics were obtained. Outcomes were procedure-related complications, especially post-ERCP pancreatitis (PEP), stone clearance, and mortality.
307 patients were identified. In 264 of the patients, the rendezvous cannulation technique was successful (86 %); in the remaining 43 patients, conventional cannulation technique was necessary. In total, PEP occurred in seven patients (2.28 %). One of the PEP patients was in the rendezvous cannulated group (0.37 %), whereas six patients developed PEP in the nonrendezvous group (13.95 %, p < 0.001). The primary stone clearance rate was 88.27 % (271/307). There was no mortality within 90 days in the series.
IOERC with RV cannulation technique for management of CBDS during laparoscopic cholecystectomy has a low PEP rate and a high stone clearance rate, making it a safe and feasible method for removing CBDS. However, the technique requires logistics to perform IOERC in the operating theater. The present data suggest that IOERC with RV cannulation is superior to conventional cannulation with respect to risk of PEP.
经内镜逆行胰胆管造影（ERCP）会师术（RV-IOERC），又称导丝辅助 IOERC，是腹腔镜胆囊切除术中处理胆总管结石（CBDS）的一种单阶段选择方案之一。本研究旨在探讨 IOERC 患者相关的操作并发症及结石清除情况。
从哈丁格的卡罗林斯卡大学医院的当地登记处确定了 2000 年 1 月至 2009 年 12 月期间接受 IOERC 的所有患者。研究了病历和 ERCP 报告，并获得了描述性统计数据。结果为与操作相关的并发症，尤其是 ERCP 后胰腺炎（PEP）、结石清除率和死亡率。
共确定了 307 名患者。在 264 名患者中， rendezvous 插管技术成功（86%）；在其余 43 名患者中，需要采用常规插管技术。总共 7 名患者（2.28%）发生了 PEP。PEP 患者中有 1 名在 rendezvous 插管组（0.37%），而非 rendezvous 组有 6 名患者发生 PEP（13.95%，p<0.001）。原发性结石清除率为 88.27%（271/307）。本系列无 90 天内死亡病例。
腹腔镜胆囊切除术中经 RV 插管技术进行 IOERC 治疗 CBDS 的 PEP 发生率低，结石清除率高，是一种安全可行的 CBDS 清除方法。但是，该技术需要后勤保障才能在手术室进行 IOERC。本数据提示，与传统插管相比，经 RV 插管的 IOERC 具有较低的 PEP 风险。
