Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
Hofstra Northwell School of Medicine, Northwell Health System, Department of Anesthesia, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
J Gastrointest Surg. 2018 Mar;22(3):451-459. doi: 10.1007/s11605-017-3588-6. Epub 2017 Oct 2.
Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups.
A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group).
Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007).
The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.
分次内镜逆行胰胆管造影（ERCP）和腹腔镜胆囊切除术（LC）是住院胆管结石病的常规治疗方法。我们的目标是比较单次手术期 LC 和 ERCP 与多次手术期 LC 和 ERCP 对同一住院期间和 30 天内的治疗效果，对于这三种方法的比较，目前数据有限。
对接受 ERCP 和 LC 的住院胆管结石患者进行回顾性研究。比较单次手术期 ERCP+LC（SOS 组）和分次住院 ERCP+LC（DH 组）与对照组：同一住院期间分次行 ERCP+LC（SH 组）。
在 214 例患者中，37 例（17%）在单次手术期行 LC+ERCP（SOS 组），130 例（60.7%）在同一住院期间分次行 LC+ERCP（SH 组），47 例（22%）在不同住院期间行 LC+ERCP，在 30 天内（DH 组）。在疗效或不良事件方面，三组间无统计学差异。与 SH 组和 DH 组相比，SOS 组的平均住院时间明显更短（5.46 对 7.15 对 9.38；p=0.05 和 0.02）。与 SH 组相比，SOS 组的总治疗费用明显降低（59221 美元对 75808 美元；p=0.007）。
与分次手术相比，SOS 方法安全、有效且具有成本效益。在患者更愿意接受单次麻醉而不影响技术成功率和安全性的情况下，可以考虑采用这种方法。
