Common bile duct stone characteristics: Correlation with treatment choice during laparoscopic cholecystectomy

被引:16
作者
Duensing, RA
Williams, RA
Collins, JC
Wilson, SE
机构
[1] Univ Calif Irvine, Med Ctr, Dept Surg, Orange, CA 92868 USA
[2] Long Beach Vet Affairs Med Ctr, Surg Serv, Long Beach, CA USA
关键词
bile duct stones; management; characteristics; decisions;
D O I
10.1016/S1091-255X(00)80027-X
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Determining the most appropriate management approach for patients with unsuspected choledocholithiasis may be difficult because of the subjective nature of this decision in the absence of clinical data. Treatment of incidental choledocholithiasis during laparoscopic cholecystectomy was relieved during a 25-month period. Operative cholangiographs were analyzed retrospectively to determine if associations exist between common bile duct stone characteristics and the intraoperative treatment selected by the operating surgeon. Cholangiographic data included quantification of common bile duct stunts, stone dimension, position, and presence of radiopaque contrast: flow into the duodenum. Two hundred thirty-six laparoscopic cholecystectomy patients underwent operative cholangiography; 25 (11%) demonstrated choledocholithiasis. Seven patients were converted to open common bile duct exploration (group I), 16 patients were referred for postoperative endoscopic retrograde cholangiopancreatography (group II), and two patients were observed (group III). Evaluation of the operative cholangiograms revealed multiple common bile duct stones (>1) in 86% (6 of 7) in group I, 25% (4 of 16) in group II, and none in group III. All patients in group I had at least one stone larger than 5 ml in greatest diameter, whereas only 33% (6 of 18)in groups TT and III combined had stones larger than 5 mi. Group I hall significantly (P = 0.027) more representation of delayed or no contrast flow during operative cholangiography compared to groups II and III. The intraoperative decision to proceed with laparoscopic cholecystectomy and rely on post operative endoscopic retrograde cholangiopancreatography for stone retrieval rather than open common bile duct exploration was associated with (1) a single common bile duct stone, less than or equal to 5 mi in size on operative cholangiogram and (2) normal contrast flow into the duodenum. Open common bile duct exploration was more frequently associated with the demonstration of multiple or large (>5 ml) stones. A periampullary stone did not discriminate among treatment choices.
引用
收藏
页码:6 / 12
页数:7
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