Huynh C H, Van de Stadt J, Devière J, Mehdi A, el Nakadi I, Cremer M, Lambilliotte J P, Gelin M
Department of Medicosurgical Gastroenterology Erasme Hospital, Université Libre de Bruxelles, Belgium.
Hepatogastroenterology. 1996 Nov-Dec;43(12):1484-91.
BACKGROUND/AIMS: The place of endoscopic retrograde cholangiopancreatography (ERCP) before open or laparoscopic cholecystectomy remains controversial. Most of the reports study highly selected series of patients and therefore do not give a survey of the actual situation in a general population. We describe here the therapeutic impact of preoperative ERCP in a continuous cohort of patients needing a cholecystectomy.
Data concerning a 2-year continuous and unselected series of 452 patients undergoing cholecystectomy were evaluated.
Two hundred ninety-three patients (65%) presented with a chronic symptomatic biliary lithiasis and 159 patients (35%) with a complicated biliary lithiasis. A preoperative ERCP was performed in 206 patients, all presenting with a suspicion of associated lithiasis of the common bile duct (CBD). An endoscopic sphincterotomy was performed in 106 patients: 44 patients presented with CBD stones (9.7%), all successfully cleared by endoscopy. Laparoscopic cholecystectomy has been attempted in 367 patients (81%) and successfully performed in 333 patients (74%). Laparotomy as a first-choice procedure was performed in 85 patients (19%). Surgical choledochotomy was never performed. Postoperative ERCP was needed in 4 patients (0.88%) and in only 1 of them for a retained CBD stone (0.22%).
In a continuous series of patients needing a cholecystectomy, preoperative ERCP was performed on the basis of suspected CBD disorders. It allows CBD stone detection and extraction in almost 10% of the patients and avoids peroperative CBD exploration, with a very low rate of retained stones after surgery. The association of preoperative ERCP with subsequent laparoscopic cholecystectomy (when feasible) offers the patient a quick recovery and a short hospital stay.
背景/目的：在开腹或腹腔镜胆囊切除术之前进行内镜逆行胰胆管造影（ERCP）的地位仍存在争议。大多数报告研究的是经过高度挑选的患者系列，因此并未对普通人群的实际情况进行全面调查。我们在此描述术前ERCP对一组连续的需要进行胆囊切除术的患者的治疗影响。
对452例接受胆囊切除术的患者进行了为期2年的连续且未经过挑选的系列数据评估。
293例患者（65%）表现为慢性症状性胆石症，159例患者（35%）表现为复杂性胆石症。206例患者进行了术前ERCP，所有患者均怀疑伴有胆总管结石（CBD）。106例患者进行了内镜括约肌切开术：44例患者存在CBD结石（9.7%），所有结石均通过内镜成功清除。367例患者（81%）尝试进行腹腔镜胆囊切除术，333例患者（74%）成功完成。85例患者（19%）将开腹手术作为首选术式。从未进行过手术胆管切开术。4例患者（0.88%）需要术后ERCP，其中仅1例是因为残留CBD结石（0.22%）。
在一组连续的需要进行胆囊切除术的患者中，术前ERCP是基于怀疑的CBD疾病进行的。它能在近10%的患者中检测并取出CBD结石，避免术中对CBD进行探查，术后残留结石率非常低。术前ERCP与随后的腹腔镜胆囊切除术（如可行）相结合，可为患者提供快速康复和较短的住院时间。
