外置牵引线腹腔镜下胆总管切开取石的临床研究

目的:探讨外置牵引线腹腔镜联合纤维胆道镜治疗胆总管结石的临床应用价值。方法:于腹腔镜下外置胆总管牵引线胆总管切开纤维胆道镜取石,治疗胆总管结石50例。结果:手术均获成功,该方法术中操作方便,创伤小,出血少,术后恢复快,平均住院时间短。结论:外置牵引线腹腔镜联合纤维胆道镜治疗胆总管结石是一种微创、安全、可靠、有效的新技术,操作方便,疗效明显。     

“Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic review”

Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients.We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients.MethodsA literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients.ResultsTwelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1–80). Procedure related mortality was 0.7%. The recurrence rate was 7%.ConclusionPercutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions.