Center of Excellence for Technical Innovation in Surgery, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, 80131 Napoli, Italy.
World J Gastrointest Surg. 2013 Jun 27;5(6):161-6. doi: 10.4240/wjgs.v5.i6.161.
The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%, depending on the patient's age. Development of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Surgery and improvement of diagnostic procedures have influenced new approaches to the management of common bile duct stones in association with gallstones. At present available minimally-invasive treatments of cholecysto-choledocal lithiasis include: single-stage laparoscopic treatment, perioperative endoscopic treatment and endoscopic treatment alone. Published data evidence that, associated endoscopic-laparoscopic approach necessitates increased number of procedures per patient while single-stage laparoscopic treatment is associated with a shorter hospital stay. However, current data does not suggest clear superiority of any one approach with regard to success, mortality, morbidity and cost-effectiveness. Considering the variety of therapeutic options available for management, a critical appraisal and decision-making is required. Endoscopic retrograde cholangiopancreatography/EST should be adopted on a selective basis, i.e., in patients with acute obstructive suppurative cholangitis, severe biliary pancreatitis, ampullary stone impaction or severe comorbidity. In a setting where all facilities are available, decision in the selection of the therapeutic option depends on the patients, the number and size of choledocholithiasis stones, the anatomy of the cystic duct and common bile duct, the surgical history of patients and local expertise.
胆石症患者合并胆总管结石的发生率约为 10%-33%，具体取决于患者的年龄。内镜逆行胰胆管造影术和腹腔镜手术的发展以及诊断程序的改进，影响了与胆囊结石相关的胆总管结石的新治疗方法。目前，胆囊胆管结石的微创治疗方法包括：一期腹腔镜治疗、围手术期内镜治疗和单纯内镜治疗。已发表的数据表明，内镜-腹腔镜联合治疗方法会增加每位患者的治疗次数，而一期腹腔镜治疗与较短的住院时间相关。然而，目前的数据并没有表明任何一种方法在成功率、死亡率、发病率和成本效益方面具有明显优势。鉴于可供管理选择的治疗方案种类繁多，需要进行批判性评估和决策。内镜逆行胰胆管造影术/EST 应根据患者的具体情况进行选择，即适用于急性梗阻性化脓性胆管炎、重症胆源性胰腺炎、壶腹结石嵌顿或严重合并症的患者。在所有设施都具备的情况下，治疗方案的选择取决于患者、胆总管结石的数量和大小、胆囊管和胆总管的解剖结构、患者的手术史和当地专业知识。
