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夺回胆管!急性外科医生的腹腔镜胆总管探查术。

Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon.

作者信息

Cironi Katherine, Martin Matthew J

机构信息

LAC USC Medical Center, Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California, USA.

Division of Trauma and Surgical Critical Care, LAC USC Medical Center, Los Angeles, California, USA.

出版信息

Trauma Surg Acute Care Open. 2025 Apr 14;10(Suppl 1):e001821. doi: 10.1136/tsaco-2025-001821. eCollection 2025.


DOI:10.1136/tsaco-2025-001821
PMID:40255986
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12004475/
Abstract

Laparoscopic common bile duct exploration (LCBDE) has emerged as a viable and effective alternative to the traditional multistage management of choledocholithiasis involving preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). Despite its advantages, LCBDE remains underused, particularly among trauma and acute care surgeons, due to its technical challenges and limited training opportunities. This practical review examines advancements in LCBDE technology, exploring its clinical applications, outlining key steps for its successful implementation, and evaluating selected current literature. Multiple studies have demonstrated that LCBDE achieves comparable success rates to ERCP and reduces hospital length of stay, overall costs, and the need for additional procedures. However, barriers to widespread adoption persist, primarily related to the technical learning curve, limited exposure during surgical training, and institutional workflow constraints favoring ERCP. With recent advancements in surgical technology and enhanced training models, LCBDE is becoming increasingly adoptable. Given their frequent management of biliary abnormality, trauma and acute care surgeons should develop proficiency in this technique to optimize patient outcomes and minimizing procedural burden.

摘要

腹腔镜胆总管探查术(LCBDE)已成为一种可行且有效的替代方法,可替代涉及术前或术后内镜逆行胰胆管造影术(ERCP)的胆总管结石传统多阶段管理方法。尽管具有优势,但由于其技术挑战和有限的培训机会,LCBDE的使用仍然不足,尤其是在创伤和急性 care 外科医生中。本实用综述探讨了LCBDE技术的进展,探索其临床应用,概述其成功实施的关键步骤,并评估选定的当前文献。多项研究表明,LCBDE的成功率与ERCP相当,并缩短了住院时间、降低了总体成本以及减少了额外手术的需求。然而,广泛采用的障碍仍然存在,主要与技术学习曲线、手术培训期间的有限接触以及有利于ERCP的机构工作流程限制有关。随着手术技术的最新进展和强化培训模式,LCBDE越来越易于采用。鉴于创伤和急性 care 外科医生经常处理胆道异常情况,他们应熟练掌握该技术,以优化患者预后并最小化手术负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5138/12004475/f35986801dde/tsaco-10-Suppl_1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5138/12004475/cd7d957c4d36/tsaco-10-Suppl_1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5138/12004475/f35986801dde/tsaco-10-Suppl_1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5138/12004475/cd7d957c4d36/tsaco-10-Suppl_1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5138/12004475/f35986801dde/tsaco-10-Suppl_1-g002.jpg

相似文献

[1]
Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon.

Trauma Surg Acute Care Open. 2025-4-14

[2]
The Laparoscopy in Biliary Exploration Research and Training Initiative (LIBERTI) trial: simulator-based training for laparoscopic management of choledocholithiasis.

Surg Endosc. 2024-2

[3]
Laparoscopic common bile duct exploration is an effective, safe, and less-costly method of treating choledocholithiasis.

Surg Endosc. 2024-10

[4]
Laparoscopic common bile duct exploration by acute care surgeons saves time and money compared to ERCP.

Am J Surg. 2022-7

[5]
Surgical versus endoscopic treatment of bile duct stones.

Cochrane Database Syst Rev. 2013-12-12

[6]
Surgical versus endoscopic treatment of bile duct stones.

Cochrane Database Syst Rev. 2013-9-3

[7]
Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons.

Surg Endosc. 2021-9

[8]
Making common duct exploration common-balloon sphincteroplasty as an adjunct to transcystic laparoscopic common bile duct exploration for pediatric patients.

J Pediatr Surg. 2023-1

[9]
Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta-analysis.

Surg Endosc. 2021-3

[10]
Comparison of Efficacy of ERCP+LC and LC+LCBDE on Cholecysto-Choledocholithiasis and Analysis of Risk Factors for Recurrence of Choledocholithiasis.

Altern Ther Health Med. 2024-7

本文引用的文献

[1]
Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: a systematic review and meta-analysis.

Front Surg. 2025-1-8

[2]
Clinical application of indocyanine green fluorescence navigation technique in laparoscopic common bile duct exploration for complex hepatolithiasis.

BMC Surg. 2024-4-20

[3]
Single-Stage Laparoscopic Common Bile Duct Exploration and Cholecystectomy Versus Two-Stage Endoscopic Stone Extraction Followed by Laparoscopic Cholecystectomy for Patients With Cholelithiasis and Choledocholithiasis: A Systematic Review.

Cureus. 2024-2-22

[4]
Comparative Analysis of Laparoscopic Versus Open Procedures in Specific General Surgical Interventions.

Cureus. 2024-2-19

[5]
Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials.

Eur Rev Med Pharmacol Sci. 2023-5

[6]
Laparoscopic Common Bile Duct Exploration.

JAMA Surg. 2023-7-1

[7]
Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials.

Surg Endosc. 2023-3

[8]
Outcomes following balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration.

Surg Endosc. 2023-5

[9]
Common bile duct stones management: A network meta-analysis.

J Trauma Acute Care Surg. 2022-11-1

[10]
Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis.

Surg Endosc. 2021-11

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