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1、1.文章来源：THELANCET.Vol.351.January17,1998DepartmentofSurgery,GastrointestinalUnit,NorfolkandNorwichNHSTrustHospital,NorwichNR13SR,UK(MRhodesFRCS,LSussmanFRCS,LCohenFRCS,MPLewisFRCS)Randomisedtrialoflaparoscopicexplorationofcommonbileductversuspostoperativeendoscopic
2、retrogradecholangiographyforcommonbileductstones胆总管腹腔镜探查术与术后内镜逆行胆管造影治疗胆总管结石的随机比较试验Summary摘要Background:Themanagementofstonesinthecommonbileductinthelaparoscopiceraiscontroversial.Thethreemajoroptionsarepreoperativeendoscopicretrogradecholangiography(ERCP),laparosco
3、picexplorationofthecommonbileduct(LECBD),orpostoperativeERCP.背景：在腹腔镜时代，处理胆总管结石是有争议的。三种主要选择是：术前内镜逆行胆管造影（ERCP），腹腔镜胆总管探查术（LECBD）,或术后内镜逆行胆管造影。Methods:BetweenAugust,1995,andAugust,1997,471laparoscopiccholecystectomiesweredoneinourdepartment.In427(91%),satisfactorypreop
4、erativecholangiographywasobtained.In80(17%)ofthesecasestherewerestonesinthecommonbileduct.40patientswererandomisedtoLECBDand40topostoperativeERCP.IfLECBDfailed,patientshadeitheropenexplorationofthecommonbileductorpostoperativeERCP.IfonepostoperativeERCPfailed,thep
5、rocedurewasrepeateduntilthecommonbileductwasclearedofstonesoranendoprosthesiswasplacedtopreventstoneimpaction.Theprimaryendpointswereduct-clearancerates,morbidity,operatingtime,andhospitalstay.Analyseswerebyintentiontotreat.方法：1995年8月至1997年8月，471患者行腹腔镜胆囊切除术。其中427例
6、（91%）获得满意的术前胆管造影结果。80例（17%）存在胆总管结石。40名患者随机进行了腹腔镜胆总管探查术，40名患者随机进行了术后内镜逆行胆管造影。若腹腔镜胆总管探查术失败，患者可行开腹探查胆总管或术后内镜逆行胆管造影。如一次术后内镜逆行胆管造影不行，可行多次直至清除胆总管结石或者放置内镜置管防止结石嵌顿。主要检测指标为，胆道清除率、发病率、手术时间和住院时间。统计学采用意向性分析。Findings:Ageandsexdistributionofpatientswassimilarintherandomisedgrou
7、ps.Ductclearanceafterthefirstinterventionwas75%inbothgroups.Bytheendoftreatment,ductclearancewas100%inthelaparoscopicgroupcomparedwith93%intheERCPgroup.Durationoftreatmentwasamedianof90min(range25–310)inthelaparoscopicgroup(includingERCPsforfailedLECBD)comparedwit
8、h105min(range60–255)inthepostoperativeERCPgroup(p=0.1,95%CIfordifference-5to40).Hospitalstaywasamedianof1day(range1–26)inthelaparoscopicgroupcomparedwit
