Paik Kyu-Hyun, Lee Yoon Suk, Park Won-Suk, Shin Yong Chan, Paik Woo Hyun
Department of Internal Medicine, St. Mary's Daejeon Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Korea.
J Clin Med. 2021 Sep 22;10(19):4297. doi: 10.3390/jcm10194297.
About 10% of patients with gallbladder (GB) stones also have concurrent common bile duct (CBD) stones. Laparoscopic cholecystectomy (LC) after removal of CBD stones using endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used method for treating coexisting gallbladder and common bile duct stones. We evaluated the optimal timing of LC after ERCP according to clinical factors, focusing on preoperative relief of jaundice.
A total of 281 patients who underwent elective LC after ERCP because of choledocholithiasis and cholecystolithiasis from January 2010 to April 2018 were retrospectively reviewed. We compared the hospital stay, perioperative morbidity, and rate of surgical conversion to open cholecystectomy according to the relief of jaundice before surgery. These enrolled patients were divided into two groups: relief of jaundice before surgery (group 1, = 125) or not (group 2, = 156).
The initial total bilirubin level was higher in group 1; however, there were no significant differences in the other baseline characteristics including age, sex, American Society of Anesthesiologists score, previous surgical history, white blood cell count, C-reactive protein, and operative time between the two groups. There was also no significant difference in postoperative hospital stay between the two groups (4.5 ± 3.3 vs. 5.5 ± 5.6 days, = 0.087). However, after ERCP, the waiting time until LC was significantly longer in group 1 (5.0 ± 4.9 vs. 3.5 ± 2.4 days, < 0.001). There were no statistical differences in the conversion rate (3.2% vs. 3.8%, = 0.518) or perioperative morbidity (4.0% vs. 5.8%, = 0.348), either.
LC would not be delayed until the relief of jaundice after ERCP since there were no significant differences in perioperative morbidity or surgical conversion rate to open cholecystectomy. Early LC after ERCP may be feasible and safe in patients with cholangitis and cholecystolithiasis.
约10%的胆囊结石患者同时合并胆总管结石。在内镜逆行胰胆管造影术（ERCP）取出胆总管结石后行腹腔镜胆囊切除术（LC）是治疗胆囊和胆总管并存结石最常用的方法。我们根据临床因素评估了ERCP术后LC的最佳时机，重点关注术前黄疸的缓解情况。
回顾性分析2010年1月至2018年4月因胆总管结石和胆囊结石接受ERCP术后择期LC的281例患者。我们根据术前黄疸的缓解情况比较了住院时间、围手术期发病率以及转为开腹胆囊切除术的手术转化率。这些入选患者分为两组：术前黄疸缓解组（第1组，n = 125）和未缓解组（第2组，n = 156）。
第1组初始总胆红素水平较高；然而，两组在其他基线特征（包括年龄、性别、美国麻醉医师协会评分、既往手术史、白细胞计数、C反应蛋白和手术时间）方面无显著差异。两组术后住院时间也无显著差异（4.5±3.3天 vs. 5.5±5.6天，P = 0.087）。然而，ERCP术后，第1组直至LC的等待时间显著更长（5.0±4.9天 vs. 3.5±2.4天，P < 0.001）。在转化率（3.2% vs. 3.8%，P = 0.518）或围手术期发病率（4.0% vs. 5.8%，P = 0.348）方面也无统计学差异。
由于围手术期发病率或转为开腹胆囊切除术的手术转化率无显著差异，ERCP术后LC无需延迟至黄疸缓解。ERCP术后早期LC对胆管炎和胆囊结石患者可能是可行且安全的。
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