Herrera-Ramírez María de Los Angeles, López-Acevedo Hugo, Gómez-Peña Gustavo Adolfo, Mata-Quintero Carlos Javier
Servicio de Cirugía General, Hospital Central Norte PEMEX, Ciudad de México, México.
Servicio de Endoscopia Gastrointestinal, Hospital Central Sur PEMEX, Ciudad de México, México.
Cir Cir. 2017 Jul-Aug;85(4):306-311. doi: 10.1016/j.circir.2016.10.008. Epub 2016 Dec 23.
Concomitant cholelithiasis and choledocholithiasis is a disease where incidence increases with age and can have serious complications such as pancreatitis, cholangitis and liver abscesses, but its management is controversial, because there are minimally invasive laparoscopic and endoscopic surgical procedures.
To compare the efficiency in the management of cholelithiasis and choledocholithiasis with laparoscopic cholecystectomy with common bile duct exploration vs cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy.
Retrospective analysis of a five year observational, cross sectional multicenter study of patients with cholelithiasis and concomitant high risk of choledocholithiasis who were divided into two groups and the efficiency of both procedures was compared. Group 1 underwent laparoscopic cholecystectomy with common bile duct exploration and group 2 underwent cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy.
40 patients, 20 were included in each group, we found p=0.10 in terms of operating time; when we compared hospital days we found p=0.63; the success of stone extraction by study group we obtained was p=0.15; the complications presented by group was p=0.1 and the number of hospitalizations by group was p ≤ 0.05 demonstrating statistical significance.
Both approaches have the same efficiency in the management of cholelithiasis and choledocholithiasis in terms of operating time, success in extracting stone, days of hospitalization, postoperative complications and conversion to open surgery. However the laparoscopic approach is favourable because it reduces the number of surgical anaesthetic events and the number of hospital admissions.
胆囊结石合并胆总管结石是一种发病率随年龄增长而增加的疾病，可引发胰腺炎、胆管炎和肝脓肿等严重并发症，但其治疗存在争议，因为有微创腹腔镜和内镜手术方法。
比较腹腔镜胆囊切除术联合胆总管探查术与内镜逆行胰胆管造影术+腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效。
对一项为期五年的观察性横断面多中心研究进行回顾性分析，该研究将患有胆囊结石且伴有胆总管结石高风险的患者分为两组，比较两种手术方法的疗效。第一组接受腹腔镜胆囊切除术联合胆总管探查术，第二组接受内镜逆行胰胆管造影术+腹腔镜胆囊切除术。
40例患者，每组纳入20例，我们发现手术时间方面p = 0.10；比较住院天数时发现p = 0.63；研究组结石取出成功率为p = 0.15；两组出现的并发症p = 0.1，两组的住院次数p≤0.05，具有统计学意义。
在手术时间、结石取出成功率、住院天数、术后并发症及转为开放手术方面，两种方法治疗胆囊结石合并胆总管结石的疗效相同。然而，腹腔镜手术方法更具优势，因为它减少了手术麻醉事件的数量和住院次数。
