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How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Gastroenterology Report 2019年第4期7卷 258-262,I0001,I0002页

作者： Aldo Bove Paolo Panaccio Raffaella di Renzo gino palone Marco Ricciardiello Sara Ciuffreda Giuseppe Bongarzoni Department of Medicine Dentistry and BiotechnologyUniversity‘G.D’Annunzio’Via dei VestiniChietiItaly

Background:We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of *** goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical ***:A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage *** 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 *** patients were treated with the sequential procedure:first,we tried the transcystic procedure and,if there was a failure,we used a rendezvous *** 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 ***: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%,***-operative complications showed similar percentages for both ***,the surgical time turned out to be longer for the rendezvous ***: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 *** pre-operative parameters,such as jaundice,CBD diameters and stone diameters,have certified their reliability as good predictors of the most suitable

关键词： Common bile-duct stone transcystic laparoscopic bile-duct clearance laparoscopic common bile-duct exploration rendezvous intra-operative endoscopic retrograde cholangiography

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