经内镜经乳头胆囊支架置入术治疗急性胆囊炎后行腹腔镜胆囊切除术：手术可行性的初步研究。
Laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting for acute cholecystitis: a pilot study of surgical feasibility.
机构信息
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
出版信息
BMC Surg. 2021 Apr 7;21(1):184. doi: 10.1186/s12893-021-01182-7.
BACKGROUND
Percutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. The objective of the present study was to investigate the feasibility of laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting (ETGBS) comparing with after PTGBD.
METHODS
Intraoperative and postoperative outcomes of patients with ETGBS and PTGBD were retrospectively compared.
RESULTS
Eighteen ETGBS and ten PTGBD patients were compared. Differences in the duration of ETGBS and PTGBD [median 209 min (range 107-357) and median 161 min (range 130-273), respectively, P = 0.10], median blood loss [ETGBS 2 (range 2-180 ml) and PTGBD 24 (range 2-100 ml), P = 0.89], switch to laparotomy (ETGBS 11% and PTGBD 20%, P = 0.52), and median postoperative hospital stay [ETGBS 8 (range 4-24 days) and ETGBS 8 (range 4-16 days), P = 0.99]. Thickening of the cystic duct that occurred in 60% of the ETGBS patients and none of the PTGBD patients (P = 0.005) interfered with closure of the duct by clipping. No obstruction occurred in ETGBS patients.
CONCLUSION
ETGBS did not make laparoscopic cholecystectomy less feasible than after PTGBD. This is a pilot study, and further investigations are needed to validate the results of the present study.
背景
经皮经肝胆囊引流术（PTGBD）适用于不适合紧急手术的急性胆囊炎（AC）患者，但在等待择期手术时，外部引流管会降低生活质量（QOL）。本研究旨在比较内镜经乳头胆囊支架置入术（ETGBS）与 PTGBD 后行腹腔镜胆囊切除术的可行性。
方法
回顾性比较 ETGBS 和 PTGBD 患者的术中及术后结果。
结果
比较了 18 例 ETGBS 和 10 例 PTGBD 患者。ETGBS 和 PTGBD 的手术时间[中位数 209 分钟（范围 107-357）和中位数 161 分钟（范围 130-273），P=0.10]、中位出血量[ETGBS 2（范围 2-180ml）和 PTGBD 24（范围 2-100ml），P=0.89]、中转开腹率[ETGBS 11%和 PTGBD 20%，P=0.52]以及术后中位住院时间[ETGBS 8（范围 4-24 天）和 ETGBS 8（范围 4-16 天），P=0.99]无差异。在 60%的 ETGBS 患者中，胆囊管增厚，而在无 PTGBD 患者中无此现象（P=0.005），这会干扰夹闭胆囊管。在 ETGBS 患者中未发生阻塞。
结论
与 PTGBD 相比，ETGBS 并没有使腹腔镜胆囊切除术变得不可行。这是一项初步研究，需要进一步研究来验证本研究的结果。
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