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[胆总管结石患者“会师”技术与标准治疗术后并发症的评估]

[Evaluation of post-surgical complications between "Rendez-vous" technique vs. standard care in patients with choledocholithiasis].

作者信息

Barraza-Leones Osvaldo C, Coronado-Sarmiento Juan F, Valdivieso-Rueda Eduardo, Barrera-León Óscar J, Ramos-Clason Enrique C

机构信息

Departamento de Cirugía General, Universidad del Sinú EBZ, Seccional Cartagena, Colombia.

Departamento de Cirugía, Universidad de La Sabana, Seccional Chía, Colombia.

出版信息

Cir Cir. 2023 May 11;92(3):331-337. doi: 10.24875/CIRU.21000192.

DOI:10.24875/CIRU.21000192
PMID:37169352
Abstract

BACKGROUND

"Rendez-vous" (RV) technique is a mixed-technique which uses both laparoscopic and endoscopic skills; however, the evidence is contradictory regarding the implementation of this technique or the 2-step sequential technique (endoscopic retrograde cholangiopancreatography [ERCP] followed by laparoscopic cholecystectomy [LC]) in the management of cholecysto-choledocholitiasis.

OBJECTIVE

To estimate the association between the implementation of RV technique and the presence of post-surgical complications as primary outcome, using as comparator the 2-step sequential technique.

METHOD

An observational, analytical, retrospective study was conducted, using as exposed cohort the medical records from patients with a diagnosis of cholelithiasis, cholecystitis, or mild biliary pancreatitis. The exposed cohort underwent RV technique, while the unexposed cohort were those which underwent two step technique.

RESULTS

There was a lower post-surgical complication rate in the RV group (0%) compared with the 10.1% (p = 0.3617) in the control group. Also, RV technique showed a lesser hospitalization time (p = 0.0377) and a lesser post-surgical hospitalization time (p < 0.0001).

CONCLUSIONS

RV technique is superior when compared with the 2-step sequential technique (ERCP followed by LC), based on a better surgical success rate, a fewer complications rate and less hospitalization time.

摘要

背景

“会师”(RV)技术是一种结合了腹腔镜和内镜技术的混合技术;然而,关于该技术或两步序贯技术(内镜逆行胰胆管造影术[ERCP]后行腹腔镜胆囊切除术[LC])在胆囊胆总管结石病管理中的应用,证据存在矛盾。

目的

以两步序贯技术作为对照,评估RV技术的应用与术后并发症发生情况之间的关联,将术后并发症作为主要结局指标。

方法

进行了一项观察性、分析性、回顾性研究,将诊断为胆结石、胆囊炎或轻度胆源性胰腺炎患者的病历作为暴露队列。暴露队列接受RV技术,未暴露队列则接受两步技术。

结果

RV组的术后并发症发生率(0%)低于对照组的10.1%(p = 0.3617)。此外,RV技术的住院时间较短(p = 0.0377),术后住院时间也较短(p < 0.0001)。

结论

基于更好的手术成功率、更低的并发症发生率和更短的住院时间,RV技术与两步序贯技术(ERCP后行LC)相比更具优势。

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