Cuendis-Velázquez Adolfo, E Trejo-Ávila Mario, Rosales-Castañeda Enrique, Cárdenas-Lailson Eduardo, E Rojano-Rodríguez Martin, Romero-Loera Sujey, A Sanjuan-Martínez Carlos, Moreno-Portillo Mucio
Servicio de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, Ciudad de México, México.
Servicio de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, Ciudad de México, México.
Cir Esp. 2017 Aug-Sep;95(7):397-402. doi: 10.1016/j.ciresp.2017.07.002. Epub 2017 Jul 19.
Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy.
We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy.
A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4±12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9±7mm. Mean operative time 218.5±74min, estimated blood loss 150 (30-600)mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9±2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia.
Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients.
对于复杂的胆总管结石，目前的胆道旁路手术选择范围从开放手术到腹腔镜 - 内镜联合手术。本研究的目的是分析接受腹腔镜胆总管十二指肠吻合术治疗的复杂胆总管结石患者的治疗效果。
我们于2011年3月至2016年6月进行了一项前瞻性观察研究。纳入了患有复杂胆总管结石（经内镜逆行胰胆管造影术（ERCP）复发或未解决）且需要进行胆道旁路手术的患者。我们进行了腹腔镜胆管探查、胆总管十二指肠吻合术及术中胆管镜检查。
共纳入19例患者。我们发现女性占优势（78.9%），平均年龄较大（72.4±12岁）且合并多种疾病。大多数患者既往有胆总管结石或胆管炎发作史，模式1（最小 - 最大：1 - 7）。胆总管平均直径24.9±7mm,平均手术时间218.5±74分钟，估计失血量150（30 - 600）mL，恢复经口进食时间3.2±1天，术后住院时间4.9±2天。我们发现随访时间中位数为18（12 - 32）个月。所有患者在随访期间肝酶均恢复正常。1例患者出现残端综合征，1例患者因医院获得性肺炎死亡。
腹腔镜胆总管十二指肠吻合术联合术中胆管镜检查对于内镜手术无法解决的复杂胆总管结石患者似乎是一种安全有效的治疗方法。该手术对于高龄和合并多种疾病的患者是一个不错的选择。我们为这些患者提供了微创手术的所有优势。
