摘要
Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis.The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.Methods:A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment.According to several pre-operative parameters,141 patients had to supposedly undergo transcystic clearance of the bile duct,while 39 patients had to be treated with the rendezvous technique.All patients were treated with the sequential procedure:first,we tried the transcystic procedure and,if there was a failure,we used a rendezvous technique.We prospectively analysed each group based on a series of variables such as sex,age,operative time,success rate of proposed treatment,conversion rate,post-operative complications and hospital stay.Results:Transcystic clearance was successful in 134 out of 141 patients(95.0%),while 2 patients needed to undergo a laparo-endoscopy procedure(failure).Thirty-five out of 39 patients(89.7%)obtained common bile-duct(CBD)clearance through the rendezvous technique,while 1 patient obtained clean-up through the simple transcystic procedure(failure).Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5%and 7.7%,respectively.Post-operative complications showed similar percentages for both procedures.However,the surgical time turned out to be longer for the rendezvous technique.Conclusions:The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94%of the cases utilizing a surgical technique selected according to the patient’s case history.The pre-operative parameters,such as jaundice,CBD diameters and stone diameters,have certified their reliability as good predictors of the most suitable procedure to follow.
背景:我们采用经胆囊管取石术和Rendezvous双镜联合术中乳头切开术治疗胆囊结石合并胆总管结石。本研究旨在评估依据术前参数来选择最佳术式的可靠性。方法:共有180例胆囊结石合并胆总管结石患者接受同期治疗。根据一些术前参数,141例患者行经胆囊管胆道取石,另39例患者采用Rendezvous双镜联合治疗。所有患者采用序贯治疗:首先,尝试经胆囊管取石,如果失败的话,再采用Rendezvous双镜联合治疗。对两组患者的临床资料进行前瞻性分析,包括性别、年龄、手术时间、首选治疗方案的成功率、中转率、术后并发症及住院时间。结果:采用经胆囊管取石术的141例患者中,134例(95.0%)获得成功;但有2例治疗失败,需行双镜联合治疗。39例采用Rendezvous双镜联合治疗患者中,35例(89.7%)成功完成胆总管取石;但有1例治疗失败,转为经胆囊管成功取石。141例经胆囊管取石患者和39例Rendezvous双镜联合治疗患者中,分别有5例和3例中转行开腹胆总管取石术,中转率分别为3.5%和7.7%。两种治疗方式术后并发症发生率相当,但Rendezvous双镜联合治疗患者手术时间相对更长。结论:根据患者的术前参数来选择合理的术式,同期手术治疗胆囊合并胆总管结石可获得94%的治疗成功率。包括黄疸水平、胆总管直径和胆石直径在内的术前参数,可作为最佳术式选择的可靠依据。
