Hospital São José, General Surgery Service - Criciúma (SC), Brazil.
Santa Casa de Misericórdia, Hepatobiliopancreatic and Liver Transplant Service - Porto Alegre (RS), Brazil.
Arq Bras Cir Dig. 2024 Aug 19;37:e1816. doi: 10.1590/0102-6720202400023e1816. eCollection 2024.
The recommended treatment for cholecystocholedocholithiasis is cholecystectomy (CCT) associated with endoscopic retrograde cholangiopancreatography (ERCP). CCT with intraoperative ERCP is associated with higher success rates and lower hospital stays and hospital costs. However, some case series do not describe the exact methodology used: whether ERCP or CCT was performed first.
Verify if there is a difference, in terms of outcomes and complications, when intraoperative ERCP is performed immediately before or after CCT.
This is a retrospective case-control study analyzing all patients who underwent CCT with intraoperative ERCP between January 2021 and June 2022, in a tertiary hospital in southern Brazil, for the treatment of cholecystocholedocholithiasis.
Out of 37 patients analyzed, 16 (43.2%) underwent ERCP first, immediately followed by CCT. The overall success rate for the cannulation of the bile duct was 91.9%, and bile duct clearance was achieved in 75.7% of cases. The post-ERCP pancreatitis rate was 10.8%. When comparing the "ERCP First" and "CCT First" groups, there was no difference in technical difficulty for performing CCT. The "CCT First" group had a higher rate of success in bile duct cannulation (p=0.020, p<0.05). Younger ages, presence of stones in the distal common bile duct and shorter duration of the procedure were factors statistically associated with the success of the bile duct clearance. Lymphopenia and cholecystitis as an initial presentation, in turn, were associated with failure to clear the bile duct.
There was no significant difference in terms of complications and success in clearing the bile ducts among patients undergoing CCT and ERCP in the same surgical/anesthetic procedure, regardless of which procedure was performed first. Lymphopenia and cholecystitis have been associated with failure to clear the bile duct.
推荐的胆石性胆-胰管疾病治疗方法是胆囊切除术（CCT）联合内镜逆行胰胆管造影术（ERCP）。术中 ERCP 联合 CCT 可提高成功率，减少住院时间和费用。然而，有些病例系列并未描述确切的方法：是先进行 ERCP 还是先进行 CCT。
验证术中 ERCP 是在 CCT 之前还是之后立即进行，在结局和并发症方面是否存在差异。
这是一项回顾性病例对照研究，分析了 2021 年 1 月至 2022 年 6 月间，在巴西南部一家三级医院因胆石性胆-胰管疾病行 CCT 术中 ERCP 的所有患者。
在分析的 37 例患者中，16 例（43.2%）先进行 ERCP，随后立即进行 CCT。胆管插管的总体成功率为 91.9%，75.7%的病例实现了胆管清除。术后 ERCP 胰腺炎的发生率为 10.8%。比较“ERCP 首先”和“CCT 首先”两组，在 CCT 操作的技术难度方面没有差异。“CCT 首先”组胆管插管成功率更高（p=0.020，p<0.05）。年龄较小、胆总管下段结石和手术时间较短是胆管清除成功的统计学相关因素。相反，淋巴细胞减少症和胆囊炎作为初始表现与胆管清除失败相关。
在同一手术/麻醉程序中进行 CCT 和 ERCP 的患者，无论先进行哪种程序，在并发症和胆管清除成功率方面没有显著差异。淋巴细胞减少症和胆囊炎与胆管清除失败有关。
