Chaouch Mohamed Ali, Dougaz Mohamed Wejih, Jerraya Hichem, Khalfallah Mehdi, Ghariani Wafa, Nouira Ramzi, Bouasker Ibtissem, Dziri Chadli
Tunis Med. 2019 Aug-Sep;97(8-9):997-1004.
The ideal mini-invasive management of common bile duct stones (CBDS) with concomitant gallbladder stones is debatable. This article aims to review the management of this condition during the last decade using the mini-invasive approach.
A database research in Medline, Embase, Cochrane and Google Scholar during the period between January 2009 to December 2018 was performed. The keywords used were «ERCP», «common bile duct exploration», «endoscopic sphincterotomy», «laparoscopic surgery», «laparoscopic cholecystectomy», «choledocholithiasis», «common bile duct stones» «meta-analysis» and «randomized clinical trials».
There were 14 studies comparing mini-invasive procedures. There were nine meta-analysis, three reviews articles and two randomized clinical trials. We concluded to the absence of difference between the group laparoscopic cholecystectomy (LC) with a laparoscopic exploration of CBD (LECBD) and LC with endoscopic retrograde cholangiopancreatography (ERCP) in terms of mortality, morbidity, stones extraction success rate and duration of hospital stay. LC + ERCP is superior in terms of conversion and treatment cost. Concerning LC with a preoperative ERCP versus LC with postoperative ERCP, based on the literature data, no conclusions could be drawn. Concerning LC with LECBD versus LC with preoperative ERCP, we conclude to the absence of difference in terms of mortality, morbidity and conversion rate. Given the discordance of the results, in terms of successful extraction rate of stones, operating time and duration of hospital stay we cannot conclude to the superiority of one technique. Concerning LC with LECBD versus LC with postoperative ERCP, we conclude the absence of difference in terms of mortality, morbidity, the success rate of stones extraction, duration of hospital stays and conversion rate. Concerning LC with intraoperative ERCP versus LC with preoperative ERCP, we concluded to the absence of difference in terms of mortality, morbidity and rate of success stones extraction. The LC + intraoperative ERCP was superior in terms of hospital stay duration and conversion rate. Concerning one-stage versus two-stage treatment, we concluded to the absence of difference in terms of mortality, morbidity, the success rate of stone extraction, the conversion rate and the duration of hospital stay.
One-stage or two-stages procedures are feasible and safe with equivalent efficacy. Surgeons must be aware of the different difficulties of these procedures and should be judicious in their use of different techniques.
对于合并胆囊结石的胆总管结石（CBDS），理想的微创治疗方法存在争议。本文旨在回顾过去十年中采用微创方法治疗这种疾病的情况。
在2009年1月至2018年12月期间，对Medline、Embase、Cochrane和谷歌学术进行了数据库检索。使用的关键词为“ERCP”、“胆总管探查”、“内镜括约肌切开术”、“腹腔镜手术”、“腹腔镜胆囊切除术”、“胆总管结石病”、“胆总管结石”、“荟萃分析”和“随机临床试验”。
有14项研究比较了微创治疗方法。其中有9项荟萃分析、3篇综述文章和2项随机临床试验。我们得出结论，在死亡率、发病率、结石取出成功率和住院时间方面，腹腔镜胆囊切除术（LC）联合腹腔镜胆总管探查术（LECBD）组与LC联合内镜逆行胰胆管造影术（ERCP）组之间没有差异。LC + ERCP在中转率和治疗费用方面更具优势。关于术前ERCP的LC与术后ERCP的LC，根据文献数据，无法得出结论。关于LECBD的LC与术前ERCP的LC，我们得出结论，在死亡率、发病率和中转率方面没有差异。鉴于结果不一致，在结石取出成功率、手术时间和住院时间方面，我们无法得出一种技术更具优势的结论。关于LECBD的LC与术后ERCP的LC，我们得出结论，在死亡率、发病率、结石取出成功率、住院时间和中转率方面没有差异。关于术中ERCP的LC与术前ERCP的LC，我们得出结论，在死亡率、发病率和结石取出成功率方面没有差异。LC + 术中ERCP在住院时间和中转率方面更具优势。关于一期治疗与二期治疗，我们得出结论，在死亡率、发病率、结石取出成功率、中转率和住院时间方面没有差异。
一期或二期手术可行且安全，疗效相当。外科医生必须意识到这些手术的不同难度，并应明智地使用不同技术。
