Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: a retrospectively cohort study
Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: a retrospectively cohort study
复制标题
腹腔镜会合与 ERCP 后行腹腔镜胆囊切除术治疗胆囊胆总管结石：一项回顾性队列研究
DOI：
10.1007/s00464-019-07051-y
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发表时间：
2020-06-01
影响因子：
3.1
通讯作者：
Sun, Quan
中科院分区：
文献类型：
--
作者：
Qian, Yawei;Xie, Jianglin;Sun, Quan
背景胆囊胆总管结石（CCL）的治疗方法多种多样。虽然手术方法的选择是术前ERCP和腹腔镜胆囊切除术（ERCP + LC），争议仍然存在关于哪种程序是最佳的CCL.MethodsTo评估腹腔镜会合（LERV）与ERCP + LC的CCL的安全性和有效性，共528例CCL患者进行了回顾性研究，从2013年1月至2018年12月。患者计划接受LERV或ERCP + LC手术。LERV组123例，ERCP + LC组137例。结果LERV组胰腺炎发生率低于ERCP + LC组（3/123 vs. 12/137，P = 0.0291），LERV组胰腺炎发生率低于ERCP + LC组（12/137，P= 0.0291）。LERV组ERCP术后淀粉酶中位数明显低于LERV组（202.5 U/dL vs.328.1 U/dL，P< 0.01）。但是，两组之间的结石清除率或其他早期并发症无显著差异。LERV组的住院时间和住院费用均少于ERCP + LC组（12天比18天，P< 0.01; 53591.4元比60089.2元，P< 0.01）。二期手术组术后胆道并发症发生率高于一期手术组（34/137 vs. 4/123，P< 0.05）。结论LERV技术是治疗CCL合并下段胰腺炎的一种安全有效的方法，其术后胆道并发症少，住院时间短，费用少，但手术时间明显延长。
BackgroundThere are a variety of strategies for the treatment of patients with cholecysto-choledocholithiasis (CCL). Although the surgical approach of choice is preoperative ERCP and laparoscopic cholecystectomy (ERCP + LC), controversy remains regarding which procedure is optimal for CCL.MethodsTo evaluate the safety and effectiveness of laparoendoscopic rendezvous (LERV) versus ERCP + LC for CCL, a total of 528 patients with CCL were retrospectively studied from January 2013 to December 2018. The patients were scheduled to undergo either the LERV or ERCP + LC procedure. The LERV group included 123 cases, whereas the ERCP + LC group contained 137 cases. The incidence of postoperative complications, success of stone clearance, length of hospital stay, and hospitalization charges were statistically analyzed.ResultsThe incidence of pancreatitis was lower in the LERV group than in the ERCP + LC group (3/123 vs. 12/137,P= 0.0291). The median level of post-ERCP amylase was much lower in the LERV group (202.5 U/dL vs. 328.1 U/dL,P< 0.01). However, there was no significant difference in the stone clearance rate or other early complications between the two groups. Further study showed that the length of hospital stay and cost in the LERV group were less than those in the ERCP + LC group (12 days vs. 18 days,P< 0.01; 53591.4¥ vs. 60089.2¥,P< 0.01). In addition, more patients in the two-stage procedure group experienced later biliary complications compared with those in the one-stage approach group (34/137 vs. 4/123,P< 0.05). However, the median operation time was 107.7 min in the two-stage group and 139.8 min in the one-stage group (P< 0.05).ConclusionsThe LERV technique is a safe and effective approach for CCL with lower pancreatitis; it was associated with few later biliary complications, shortened hospital stays, and fewer charges but significantly longer operative time.