Lorimer J W, Lauzon J, Fairfull-Smith R J, Yelle J D
Department of Surgery, University of Ottawa, Ontario, Canada.
Am J Surg. 1997 Jul;174(1):68-71. doi: 10.1016/S0002-9610(97)00027-5.
The best way to detect and manage common duct stones in conjunction with laparoscopic cholecystectomy is not agreed upon at the present time.
Our experience with choledocholithiasis in a consecutive series of 1,123 cholecystectomies (94% by laparoscopy) has been reviewed. Suspected duct stones were investigated preoperatively or postoperatively by endoscopic retrograde cholangiography (ERC), and if necessary, duct clearance was attempted by endoscopic sphincterotomy (ES). No attempt was made to identify choledocholithiasis intraoperatively.
Endoscopic retrograde cholangiography was performed in 11% of patients, and 32% of these required ES. The complication rate of ERC and ES was 8%, without mortality. Two patients required a second operation for missed choledocholithiasis, for a reoperation rate of 0.2%.
We believe that primary or secondary open surgery is only occasionally necessary for the management of choledocholithiasis. Preoperative ERC and ES for suspected duct stones, with the same strategy employed as a salvage for stones presenting after cholecystectomy, was safe and efficient.
目前对于在腹腔镜胆囊切除术的同时检测和处理胆总管结石的最佳方法尚无定论。
回顾了我们在连续1123例胆囊切除术（94%为腹腔镜手术）中处理胆总管结石的经验。术前或术后通过内镜逆行胆管造影（ERC）对疑似胆管结石进行检查，必要时通过内镜括约肌切开术（ES）尝试清除胆管结石。术中未尝试识别胆总管结石。
11%的患者接受了内镜逆行胆管造影，其中32%的患者需要进行内镜括约肌切开术。内镜逆行胆管造影和内镜括约肌切开术的并发症发生率为8%，无死亡病例。2例患者因遗漏胆总管结石需要二次手术，再次手术率为0.2%。
我们认为，对于胆总管结石的处理，仅偶尔需要进行一期或二期开放手术。对疑似胆管结石进行术前内镜逆行胆管造影和内镜括约肌切开术，并采用与处理胆囊切除术后出现的结石相同的挽救策略，是安全有效的。
