使用可弯曲电子支气管镜进行腹腔镜胆总管探查的新技术：关于胆石症合并胆总管结石的单阶段（腹腔镜胆囊切除术和腹腔镜胆总管探查术）与双阶段（内镜逆行胰胆管造影术继以腹腔镜胆囊切除术）治疗临床结局的研究——三级医疗中心的前瞻性研究（BRACE研究——支气管镜辅助胆总管探查研究）

Novel technique for laparoscopic common bile duct exploration using flexible videobronchoscope to study on clinical outcomes of single-stage (laparoscopic cholecystectomy and laparoscopic common bile duct exploration) versus dual-stage (endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy) for cholelithiasis with choledocholithiasis - Prospective study in a tertiary care centre (BRACE study - BRonchoscope Assisted Common bile duct Exploration Study).

作者信息

Singh Pawan Kumar, Haldeniya Kulbhushan, Krishna S R, Raghavendra Annagiri

机构信息

Department of Surgical Gastroenterology, NIMS University, Jaipur, Rajasthan, India.

出版信息

J Minim Access Surg. 2024 Jul 1;20(3):278-287. doi: 10.4103/jmas.jmas_182_23. Epub 2024 Feb 9.

DOI:10.4103/jmas.jmas_182_23

PMID:38340078

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11354955/

Abstract

INTRODUCTION

This study aimed to study on clinical outcomes of single-stage (laparoscopic cholecystectomy [LC] and laparoscopic common bile duct [CBD] exploration using flexible videobronchoscope) versus dual-stage (endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy) for cholelithiasis with choledocholithiasis-prospective study in a tertiary care centre (BRACE STUDY-Bronchoscope-Assisted CBD Exploration [CBDE] Study).

PATIENTS AND METHODS

Between April 2022 and April 2023, patients who underwent LC with laparoscopic CBDE and endoscopic retrograde cholangiopancreatography (ERCP) followed by LC participated in this single-centre prospective research. The Institute Ethics Committee granted its approval after receiving an ethical review. The primary endpoint of the proposed research was the removal of the gall bladder and CBD stones. The secondary outcomes studied were complications using the Clavien-Dindo score, cost-effectiveness, patient satisfaction score and post-procedure duration of hospital stay.

RESULTS

A total of 168 patients were included in the study. The success rate of LC with laparoscopic CBD exploration using a flexible videobronchoscope (Group 1) was significantly higher as compared to ERCP f/b LC (Group 2) (96.4% vs. 84.5%, P value = 0.02). Out of the 84 patients in Group 1, direct choledochotomies were performed on 83 of them. Group 1 had a considerably shorter hospital stay (4.6 ± 2.4 vs. 5.3 ± 6.2 days; P = 0.03). Both the cost ( P = 0.002) and the number of procedures per patient ( P < 0.001) were considerably higher in Group 2. Major complications (Clavien-Dindo grade 3 and above) were significantly higher in Group 2 ( P = 0.04). Patient satisfaction in Group 1 scored more favourably than those in Group 2 (2.26 ± 0.3 vs. 1.92 ± 0.7; P = 0.006).

CONCLUSION

For concurrent gall bladder and CBD stones, single-stage management by LCBDE using a flexible videobronchoscope has a significantly better primary outcome and lower major complications than dual-stage management. The single-stage strategy also has advantages in terms of a shorter hospital stay, the need for fewer procedures, cost efficiency and patient satisfaction.

摘要

引言

本研究旨在探讨单阶段（腹腔镜胆囊切除术[LC]及使用可弯曲电子支气管镜进行腹腔镜胆总管[CBD]探查）与双阶段（内镜逆行胰胆管造影术，随后进行腹腔镜胆囊切除术）治疗胆囊结石合并胆总管结石的临床结局——在一家三级医疗中心进行的前瞻性研究（BRACE研究——支气管镜辅助CBD探查[CBDE]研究）。

患者与方法

在2022年4月至2023年4月期间，接受LC联合腹腔镜CBD探查以及接受内镜逆行胰胆管造影术（ERCP）后再行LC的患者参与了这项单中心前瞻性研究。经伦理审查后，该研究所伦理委员会批准了此项研究。本研究的主要终点是切除胆囊和CBD结石。所研究的次要结局包括使用Clavien-Dindo评分评估的并发症、成本效益、患者满意度评分以及术后住院时间。

结果

本研究共纳入168例患者。与ERCP后行LC（第2组）相比，使用可弯曲电子支气管镜进行腹腔镜CBD探查的LC（第1组）成功率显著更高（96.4%对84.5%，P值 = 0.02）。在第1组的84例患者中，83例进行了直接胆总管切开术。第1组的住院时间明显更短（4.6±2.4天对5.3±6.2天；P = 0.03）。第2组的成本（P = 0.002）和每位患者的手术次数（P < 0.001）均显著更高。第2组的严重并发症（Clavien-Dindo 3级及以上）明显更多（P = 0.04）。第1组患者的满意度评分优于第2组（2.26±0.3对1.9±0.7；P = 0.006）。