Welbourn C R, Mehta D, Armstrong C P, Gear M W, Eyre-Brook I A
Department of Surgery, Musgrove Park Hospital, Taunton.
Gut. 1995 Oct;37(4):576-9. doi: 10.1136/gut.37.4.576.
A policy of preoperative endoscopic retrograde cholangiography (ERC) for suspected bile duct stones was used in 1507 patients considered for laparoscopic cholecystectomy in three district general hospitals. Altogether 306 patients underwent ERC, and bile duct cannulation was achieved in 276 (90%). Bile ducts were cleared by endoscopic sphincterotomy in 128 of 161 patients (79%) with proven duct stones. Laparoscopic cholecystectomy was completed in 1396 patients. Ten laparotomies were necessary for complications of laparoscopic cholecystectomy. The complication rate for endoscopic sphincterotomy/laparoscopic cholecystectomy was 2.7%, with no mortality. Overall, a combined endoscopic/laparoscopic approach succeeded in 1386 patients (92%). Fourteen patients (1%) had retained stones during a median of 14 months (range 1-42) follow up, all of which were removed by ERC/endoscopic sphincterotomy. If a policy of selective ERC before laparoscopic cholecystectomy is used for all patients with symptomatic gall stones, most will avoid an open operation and laparoscopic exploration of the bile duct is not necessary.
在三家地区综合医院，1507例拟行腹腔镜胆囊切除术的患者采用了术前内镜逆行胆管造影（ERC）以诊断疑似胆管结石的策略。共有306例患者接受了ERC，其中276例（90%）成功完成胆管插管。在161例经证实有胆管结石的患者中，128例（79%）通过内镜括约肌切开术清除了胆管结石。1396例患者完成了腹腔镜胆囊切除术。因腹腔镜胆囊切除术并发症而进行了10次开腹手术。内镜括约肌切开术/腹腔镜胆囊切除术的并发症发生率为2.7%，无死亡病例。总体而言，内镜/腹腔镜联合手术在1386例患者（92%）中取得成功。在中位随访14个月（范围1 - 42个月）期间，14例患者（1%）出现结石残留，均通过ERC/内镜括约肌切开术取出。如果对所有有症状胆结石患者在腹腔镜胆囊切除术前行选择性ERC策略，大多数患者可避免开腹手术，且无需进行腹腔镜胆管探查。
