Joshi M R, Rupakheti S, Bohara T P, Singh D R
Department of surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2017 Jan-Mar;56(205):117-123.
Concomitant cholelithiasis and choledocholithiasis are commonly managed in two stage procedure, endoscopic management of common bile duct stone followed by laparoscopic cholecystectomy in different time and setting. We perform these two procedures in same sitting in operating room set up. We evaluated the procedure in terms of outcome, feasibility and complications.
Prospective cross-sectional study carried out since April 2013 to August 2016 in all patients who had undergone single stage endoscopic and laparoscopic management of concomitant cholelithiasis and choledocholithiasis. Patient's demography, procedural time for different procedure and procedure in total and post-operative complications were recorded and analyzed with suitable statistical methods.
Out of 50 cases enrolled, 2 patients were converted to open. Out of 48 patients, 3 needed re-attempt for completion. Majority were female 36 (72%), mean age was 39.48years. Mean common bile duct diameter and mean stone size was 11.43±2.63 cm and 7.99±2.01cm, respectively. Mean of total procedural time was 90.93± 33.68 minutes. In most of the cases, laparoscopic cholecystectomy performed first followed by endoscopic method (66.7%). Total procedural time was less in the patients who underwent laparoscopy first in comparison to endoscopy first. Clinically significant complications like cholangitis, pancreatitis and duodenal perforation occurred in 7 patients. Out of 4 patients who developed pancreatitis, one had severe acute pancreatitis requiring prolonged hospitalization.
Single stage management of common bile duct and gall bladder stone by laparoscopic and endoscopic method is feasible in our setup with acceptable results. Endoscopic treatment of common bile duct stone if performed first, is associated with longer procedural time.
胆囊结石合并胆总管结石通常采用两阶段手术治疗，即先进行内镜下胆总管结石治疗，然后在不同时间和环境下进行腹腔镜胆囊切除术。我们在手术室环境中一次性完成这两个手术。我们从手术结果、可行性和并发症方面对该手术进行了评估。
自2013年4月至2016年8月，对所有接受胆囊结石合并胆总管结石单阶段内镜及腹腔镜联合治疗的患者进行前瞻性横断面研究。记录患者的人口统计学资料、不同手术的操作时间、总手术时间及术后并发症，并采用适当的统计方法进行分析。
纳入的50例患者中，2例转为开腹手术。48例患者中，3例需要再次尝试以完成手术。大多数为女性，共36例（72%），平均年龄为39.48岁。胆总管平均直径和结石平均大小分别为11.43±2.63cm和7.99±2.01cm。总手术时间平均为90.93±33.68分钟。在大多数情况下，先进行腹腔镜胆囊切除术，然后采用内镜方法（66.7%）。与先进行内镜手术的患者相比，先进行腹腔镜手术的患者总手术时间更短。7例患者出现了如胆管炎、胰腺炎和十二指肠穿孔等具有临床意义的并发症。在发生胰腺炎的4例患者中，1例患有严重急性胰腺炎，需要延长住院时间。
在我们的医疗环境中，采用腹腔镜和内镜方法对胆总管结石和胆囊结石进行单阶段治疗是可行的，结果可以接受。如果先进行胆总管结石的内镜治疗，手术时间会更长。
