Sanjuanbenito A, Torres Alemán A, Meneu J C, Fernández Cebrian J M, Meroño E, Moreira V, Fresneda V
Hospital Ramón y Cajal, Madrid, Dpto. de Cirugía General y Digestiva.
Rev Esp Enferm Dig. 1996 Sep;88(9):621-4.
The development of laparoscopic cholecystectomy has rekindled the issue of management of choledocholithiasis. A number of options exist including pre or postoperative endoscopic sphincterotomy (ERCP-ES), laparoscopic common duct exploration or open common duct exploration. We present here our experience with the management of choledocholithiasis in patients treated with laparoscopic cholecystectomy. From January 1991 to January 1995, 900 patients underwent laparoscopic cholecystectomy. 71 ERCP were carried out in 71 patients with suspicion or evidence of choledocholithiasis. Common duct stones were detected in 44 patients. Preoperative ERCP was done in 56 patients, with suspicion of choledocholithiasis, based on clinical, laboratory or ultrasonographic findings. 29 of these patients (51.7%) had common duct stones, that were successfully removed by endoscopic sphincterotomy. One patient suffered mild pancreatitis and a second one had transient hyperamylasemia. Postoperative ERCP was performed in 15 patients. Indications for ERCP were the evidence of common duct stones in intraoperative cholangiography in 7 cases, and clinical or laboratory suspicion of choledocholithiasis, 3 months to 3 years after laparoscopic cholecystectomy. Stones were detected in 100% of the patients. In 11 patients (73.3%), the stones were extracted by endoscopic sphincterotomy and 4 patients underwent open common duct exploration. Two patients had transient hyperamylasemia. ERCP is a safe and effective method for detection and treatment of common duct stones. ERCP prior to laparoscopic cholecystectomy in patients suspected of having choledocholithiasis, is safe and offers with good results. Rutinary intraoperative cholangiography is recommended, for the detection of unsuspected choledocholithiasis and as an effective treatment (postoperative-ERCP, open or laparoscopic common duct exploration) can be chosen depending on surgeon's skills and patient's characteristics.
腹腔镜胆囊切除术的发展再次引发了胆总管结石处理问题。存在多种选择，包括术前或术后内镜括约肌切开术（ERCP - ES）、腹腔镜胆总管探查或开放胆总管探查。在此，我们介绍我们在接受腹腔镜胆囊切除术患者中处理胆总管结石的经验。1991年1月至1995年1月，900例患者接受了腹腔镜胆囊切除术。71例怀疑或证实有胆总管结石的患者接受了71次ERCP检查。44例患者检测到胆总管结石。56例基于临床、实验室或超声检查结果怀疑有胆总管结石的患者在术前进行了ERCP。其中29例患者（51.7%）有胆总管结石，通过内镜括约肌切开术成功取出。1例患者发生轻度胰腺炎，另1例有短暂性高淀粉酶血症。15例患者在术后进行了ERCP。ERCP的指征为术中胆管造影显示胆总管结石7例，以及腹腔镜胆囊切除术后3个月至3年临床或实验室怀疑有胆总管结石。所有患者均检测到结石。11例患者（73.3%）通过内镜括约肌切开术取出结石，4例患者接受了开放胆总管探查。2例患者有短暂性高淀粉酶血症。ERCP是检测和治疗胆总管结石的一种安全有效的方法。对于怀疑有胆总管结石的患者，在腹腔镜胆囊切除术前行ERCP是安全的且效果良好。建议常规进行术中胆管造影，以检测未被怀疑的胆总管结石，并且可根据外科医生的技术和患者的特点选择有效的治疗方法（术后ERCP、开放或腹腔镜胆总管探查）。
