- 作者：Lawrence E. Tabone ; Molly Conlon ; Emil Fern ; o ; Sophia Yi ; Sharfi Sarker ; P. Marco Fisichella ; Fred A. Luchette
- 关键词：Choledocholithiasis ; Gallstone pancreatitis ; Endoscopic retrograde cholangiopancreatography ; Intraoperative cholangiogram ; Laparoscopic cholecystectomy ; Hospital charges
- 刊名：The American Journal of Surgery
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：206
- 期：4
- 页码：472-477
- 全文大小：168 K
Background
The purpose of this study was to evaluate the outcomes of various surgeon strategies used to evaluate and treat common duct stones (CDSs) in patients presenting with mild to moderate gallstone pancreatitis (GP).Methods
We performed a retrospective review of patients admitted for mild to moderate GP. Data variables included laboratory values and radiology images, indications for and findings of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP), length of stay (LOS), and hospital charges. Data were stratified by 2 different management strategies: preoperative ERCP and then laparoscopic cholecystectomy (LC) or LC with IOC followed by selective postoperative ERCP.
Results
During this time period, 80 patients met the study criteria, 56 were treated by LC with IOC, and 24 had a preoperative ERCP performed. The incidence of CDS was 33 % (n = 26). The presence of CDSs correlated with an elevated total bilirubin at admission (CDSs 3.5 mg/dL vs 2.1 mg/dL no CDSs, P < .01) and 24 hours after admission (CDS 3.2 mg/dL vs 1.5 mg/dL no CDS, P < .01). Patients who had an IOC compared with those who had preoperative ERCP had a shorter LOS (4.6 vs 5.9 days, P?= .04) and lower hospital charges (US $28,510 vs US $38,620; P < .01).
Conclusions
Elevated total bilirubin at admission and 24 hours after admission may predict a patient's risk for CDS. We found that the management of uncomplicated GP with early LC and IOC results in decreased LOS and total hospital charges when compared with preoperative ERCP.