ElGeidie Ahmed, Atif Ehab, Naeem Yussef, ElEbidy Gamal
Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt.
Surg Laparosc Endosc Percutan Tech. 2015 Oct;25(5):e152-5. doi: 10.1097/SLE.0000000000000198.
Laparoscopic common bile duct exploration (LCBDE) has been proven to be a safe, efficient, and cost-effective option for the management of common bile duct (CBD) stones. There are two guiding methods during LCBDE: fluoroscopic or choledochoscopic. Most surgeons prefer the use of flexible choledochoscopy at LCBDE, but it is a fragile, delicate, and expensive instrument. The aim of this work was to report our experience in fluoroscopically guided LCBDE.
A retrospective review of all patients who underwent LCBDE in the Mansoura Gastroenterology surgical center between March 2007 and September 2014 was performed. Patients with gallstones and concomitant CBD stones were included. After the initial assessment, all patients fulfilling the criteria of enrollment underwent magnetic resonance cholangiopancreatography, and only patients with magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography evidence of CBD stones were included. Choledochoscopy was not used in any patient, and we depended on fluoroscopic guidance for CBD stone retrieval in all LCBDE.
A total of 290 patients were assessed for LCBDE: 76 patients were excluded; 11 patients were not completed laparoscopically due to negative intraoperative cholangiography (n=7) and conversion to laparotomy (n=4); the remaining 203 patients were analyzed. LCBDE failed in 16 of the 203 (7.9%) cases, with a success rate of 92.1%. The median operative time was 79 minutes, and the median hospital stay was 2.4 days. Complications were bile leakage (n=4), mild pancreatitis (n=2), wound infection (n=2), port hernia (n=1), and internal hemorrhage (n=1).
Compared with published studies using choledochoscopy at LCBDE, we found comparable results in terms of the success/failure rate, the morbidity and mortality, the operative time, and the length of hospital stay. LCBDE under fluoroscopic guidance may be as safe and efficient as with choledochoscopic guidance.
腹腔镜胆总管探查术（LCBDE）已被证明是治疗胆总管（CBD）结石的一种安全、高效且具有成本效益的选择。LCBDE 有两种引导方法：荧光透视引导或胆道镜引导。大多数外科医生在 LCBDE 中更喜欢使用软性胆道镜，但它是一种易碎、精细且昂贵的器械。这项工作的目的是报告我们在荧光透视引导下进行 LCBDE 的经验。
对 2007 年 3 月至 2014 年 9 月在曼苏拉胃肠病外科中心接受 LCBDE 的所有患者进行回顾性研究。纳入患有胆结石并伴有 CBD 结石的患者。在初步评估后，所有符合纳入标准的患者均接受磁共振胰胆管造影，仅纳入有磁共振胰胆管造影或内镜逆行胰胆管造影显示 CBD 结石证据的患者。所有患者均未使用胆道镜，我们在所有 LCBDE 中均依靠荧光透视引导来取出 CBD 结石。
共有 290 例患者接受 LCBDE 评估：76 例患者被排除；11 例患者因术中胆管造影阴性（n = 7）和转为开腹手术（n = 4）而未完成腹腔镜手术；其余 203 例患者进行了分析。203 例病例中有 16 例（7.9%）LCBDE 失败，成功率为 92.1%。中位手术时间为 79 分钟，中位住院时间为 2.4 天。并发症包括胆漏（n = 4）、轻度胰腺炎（n = 2）、伤口感染（n = 2）、切口疝（n = 1）和内出血（n = 1）。
与已发表的在 LCBDE 中使用胆道镜的研究相比，我们发现在成功率/失败率、发病率和死亡率、手术时间以及住院时间方面结果相当。荧光透视引导下的 LCBDE 可能与胆道镜引导下的一样安全有效。
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