Bove Aldo, Panaccio Paolo, di Renzo Raffaella, Palone Gino, Ricciardiello Marco, Ciuffreda Sara, Bongarzoni Giuseppe
Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy.
Gastroenterol Rep (Oxf). 2019 Aug;7(4):258-262. doi: 10.1093/gastro/goz022. Epub 2019 Jun 5.
We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.
A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment. According to several pre-operative parameters, 141 patients had to supposedly undergo transcystic clearance of the bile duct, while 39 patients had to be treated with the rendezvous technique. All patients were treated with the sequential procedure: first, we tried the transcystic procedure and, if there was a failure, we used a rendezvous technique. We prospectively analysed each group based on a series of variables such as sex, age, operative time, success rate of proposed treatment, conversion rate, post-operative complications and hospital stay.
Transcystic clearance was successful in 134 out of 141 patients (95.0%), while 2 patients needed to undergo a laparo-endoscopy procedure (failure). Thirty-five out of 39 patients (89.7%) obtained common bile-duct (CBD) clearance through the rendezvous technique, while 1 patient obtained clean-up through the simple transcystic procedure (failure). Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5% and 7.7%, respectively. Post-operative complications showed similar percentages for both procedures. However, the surgical time turned out to be longer for the rendezvous technique.
The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94% of the cases utilizing a surgical technique selected according to the patient's case history. The pre-operative parameters, such as jaundice, CBD diameters and stone diameters, have certified their reliability as good predictors of the most suitable procedure to follow.
我们采用经胆囊途径清除结石及术中通过会师技术行乳头切开术治疗胆囊胆管结石。本研究的目的是评估术前参数对于确定最合适手术方式的可靠性。
总共180例患有胆囊和胆管结石的患者接受了一期治疗。根据多个术前参数，141例患者理论上需行经胆囊途径清除胆管结石，而39例患者需采用会师技术治疗。所有患者均接受序贯治疗：首先尝试经胆囊途径手术，若失败则采用会师技术。我们根据一系列变量对每组患者进行前瞻性分析，这些变量包括性别、年龄、手术时间、拟行治疗的成功率、中转率、术后并发症及住院时间。
141例患者中有134例经胆囊途径清除结石成功（95.0%），2例患者需接受腹腔镜内镜手术（失败）。39例患者中有35例（89.7%）通过会师技术实现胆总管（CBD）结石清除，1例患者通过单纯经胆囊途径实现结石清除（失败）。141例经胆囊途径清除结石的患者中有5例、39例采用会师技术的患者中有3例接受了开腹胆总管结石清除术，中转率分别为3.5%和7.7%。两种手术方式术后并发症的发生率相近。然而，会师技术的手术时间更长。
利用根据患者病史选择的手术技术，94%的胆囊胆管结石患者可行一期手术治疗。术前参数，如黄疸、胆总管直径和结石直径，已证明其作为后续最合适手术方式良好预测指标的可靠性。
