Sayed Mostafa M, Abdelmohsen Ahmed Shawkat, Ibrahim Mostafa, Raafat Mohamad
Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt.
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Asyut, Egypt.
Ann Hepatobiliary Pancreat Surg. 2025 Feb 28;29(1):55-61. doi: 10.14701/ahbps.24-157. Epub 2024 Dec 23.
BACKGROUNDS/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) remains the most common therapeutic strategy used for cholecystocholedocholithiasis (CCL). Recently, single-stage ERCP + LC has gained popularity for treating CCL due to patient satisfaction and financial considerations. In this study, we aimed to compare the feasibility and efficacy of the two variants of single-stage ERCP + LC (starting with ERCP followed by LC versus starting with LC followed by ERCP) for treatment of CCL.
A total of 115 patients who underwent single-stage ERCP + LC for CCL from January 2021 to December 2023 were enrolled in a retrospective comparative cohort study. These patients were divided into two groups: Group A (ERCP-first approach) and Group B (LC-first approach).
Patients in Group A had a common bile duct clearance rate of 88.2%, which was comparable to the 95.7% observed in Group B ( = 0.163). The mean duration of the ERCP procedure was comparable between the two groups (43.3 ± 11.8 vs 39.5 ± 13.5 minutes; = 0.112). However, the mean duration of the LC procedure was significantly longer in Group A than in Group B (41.2 ± 8.98 vs 37.2 ± 12.2 minutes; = 0.045). The mean total operative time for the combined ERCP + LC was significantly longer in Group A compared to Group B (81.9 ± 16.7 vs 75.1 ± 19.3 minutes; = 0.046). Post-ERCP pancreatitis occurred in 4 patients in Group A and in 2 patients in Group B ( = 0.701).
Both LC-1st approach and ERCP-1st approach are feasible and highly effective for treating CCL through single-stage ERCP + LC. However, the LC-1st approach has the advantage of a shorter operative time.
背景/目的：内镜逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）仍然是用于治疗胆囊胆总管结石（CCL）的最常见治疗策略。近来，由于患者满意度和经济因素，一期ERCP + LC在治疗CCL方面受到欢迎。在本研究中，我们旨在比较一期ERCP + LC的两种变体（先进行ERCP然后进行LC与先进行LC然后进行ERCP）治疗CCL的可行性和疗效。
对2021年1月至2023年12月期间因CCL接受一期ERCP + LC的115例患者进行回顾性比较队列研究。这些患者被分为两组：A组（ERCP优先法）和B组（LC优先法）。
A组患者的胆总管清除率为88.2%，与B组观察到的95.7%相当（P = 0.163）。两组间ERCP操作的平均持续时间相当（43.3 ± 11.8对39.5 ± 13.5分钟；P = 0.112）。然而，A组LC操作的平均持续时间显著长于B组（41.2 ± 8.98对37.2 ± 12.2分钟；P = 0.045）。与B组相比，A组合并ERCP + LC的平均总手术时间显著更长（81.9 ± 16.7对75.1 ± 19.3分钟；P = 0.046）。A组有4例患者发生ERCP后胰腺炎，B组有2例患者发生（P = ）0.701。
通过一期ERCP + LC治疗CCL，LC优先法和ERCP优先法均可行且高效。然而，LC优先法具有手术时间较短的优势。
