单阶段腹腔镜胆总管探查术(LCBDE)和胆囊切除术加胆道内引流术治疗胆石症合并胆总管结石的围手术期效果和可行性:一家三甲医院的报告。

IF 0.9 Q4 ORTHOPEDICS Asian Journal of Endoscopic Surgery Pub Date : 2024-11-26 DOI:10.1111/ases.13418
Ankita Bajpai, Akshay Anand, Awanish Kumar, Manish Agrawal, Ajay Kumar Pal, Pankaj Kumar, Amit Karnik, Sumit Rungta, Harvinder Singh Pahwa, Abhinav Arun Sonkar
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引用次数: 0

摘要

导言:胆囊炎和胆石症的治疗方法发生了重大变化,可选择单阶段胆囊切除术和胆总管(CBD)探查术,或在胆囊切除术之前或之后进行内镜逆行胰胆管造影术(ERCP)的两阶段手术。西方国家的证据可能无法完全反映发展中国家特有的疾病负担和人口特征。与西方中心相比,印度次大陆更常进行腹腔镜胆总管探查术(LCBDE),因为复杂的ERCP病例难以获得先进的手术和专业器械。高昂的费用和管理ERCP失败病例所需的大量设备使LCBDE成为许多印度中心更可行的选择:这项前瞻性研究于 2019 年 8 月至 2020 年 7 月在印度乔治国王医科大学(King George's Medical University, UP, India)进行,共纳入 n = 24 名确诊为胆总管结石的患者。所实施的手术包括腹腔镜CBD探查和胆囊切除术,以及胆道内引流术。对围手术期的结果进行了评估,并纳入了随访数据,以监测手术后 36 个月前的复发情况:研究对象的平均年龄为 42.2 岁,83%(n =)的患者为女性。腹痛是主要症状,91.66%的患者有此症状,其次是恶心/呕吐,占 79.20%。观察到的 CBD 平均直径与现有文献一致。平均手术时间为 2.02 小时,初级管道闭合平均需要 13.66 分钟。手术中的平均失血量为 136.25 毫升。平均住院时间为 5.54 天,大部分引流管在术后第三天拔除。并发症包括25.0%的患者发烧,24例患者中有3例出现胆汁渗漏(约占12.50%)。在随访期间,一名患者(4.17%)出现结石滞留:结论:腹腔镜CBD探查加原发性管道闭合和胆道内引流似乎是一种可行的方法,围手术期效果令人满意。结论:腹腔镜CBD探查加原发性管道闭合和胆道内引流术似乎是一种可行的方法,围手术期效果令人满意。
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Perioperative Outcomes and Feasibility of Single-Stage Laparoscopic Common Bile Duct Exploration (LCBDE) and Cholecystectomy With Internal Endo-Biliary Drainage for Management of Concomitant Cholelithiasis With Choledocholithiasis: A Report From a Tertiary Care Hospital

Introduction

Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.

Methods

This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included n = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.

Results

The study population had a mean age of 42.2 years, with 83% (n = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in n = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.

Conclusion

Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.

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