Lezoche E, Paganini A M
Cattedra di Chirurgia Generale I, Università di Ancona, Italy.
Surg Endosc. 1995 Oct;9(10):1070-5. doi: 10.1007/BF00188989.
Feasibility, success rate, safety, and short-term results of single-stage, laparoscopic, transcystic--whenever possible--or choledochotomic treatment of gallstones and common bile duct (CBD) stones were evaluated in 120 unselected patients. Of 1095 patients who underwent laparoscopic cholecystectomy, 120 had ductal stones; among those patients, stones were suspected or proven in 72, 27 of whom were referred after failed endoscopic sphincterotomy (ES) performed elsewhere; unsuspected CBD stones were discovered in 48. The procedure was successful in 116 patients. Four patients required conversion to open surgery. The transcystic access was feasible in 77 patients; a choledochotomy was required in 39. Incidence of retained CBD stones was 4.3%. Minor complications, major complications, and mortality were observed in 6.8%, 1.7%, and 0.8% of patients, respectively. Single-stage laparoscopic treatment of gallstones and CBD stones in unselected patients is safe and feasible in the majority of cases, with success rates and short-term results that are not inferior to reported results of ERCP/ES and cholecystectomy.
对120例未经挑选的患者评估了单阶段腹腔镜经胆囊(只要可行)或胆总管切开术治疗胆囊结石和胆总管(CBD)结石的可行性、成功率、安全性及短期结果。在1095例行腹腔镜胆囊切除术的患者中,120例有胆管结石;在这些患者中,72例怀疑或证实有结石,其中27例是在其他地方内镜括约肌切开术(ES)失败后转诊而来;48例发现了意外的胆总管结石。该手术在116例患者中成功。4例患者需要转为开放手术。77例患者经胆囊途径可行;39例需要胆总管切开术。胆总管残留结石的发生率为4.3%。分别有6.8%、1.7%和0.8%的患者出现轻微并发症、严重并发症和死亡。对未经挑选的患者进行单阶段腹腔镜治疗胆囊结石和胆总管结石在大多数情况下是安全可行的,成功率和短期结果不低于已报道的内镜逆行胰胆管造影/内镜括约肌切开术(ERCP/ES)和胆囊切除术的结果。