Lai K H, Lin L F, Lo G H, Cheng J S, Huang R L, Lin C K, Huang J S, Hsu P I, Peng N J, Ger L P
Department of Internal Medicine, Veterans General Hospital Kaohsiung, National Yang Ming University, Taiwan, Republic of China.
Gastrointest Endosc. 1999 Apr;49(4 Pt 1):483-7. doi: 10.1016/s0016-5107(99)70047-7.
The intact gallbladder after endoscopic sphincterotomy is thought to be a potential risk factor for recurrent biliary complications. The aim of this non-randomized prospective study was to investigate whether cholecystectomy soon after endoscopic sphincterotomy could prevent the recurrence of biliary complications.
From January 1991 to October 1995, 140 patients with intact gallbladder underwent endoscopic sphincterotomy for clearance of stones in the bile duct. Of the 140 patients, 46 underwent elective cholecystectomy soon after sphincterotomy (group A) and 94 did not (group B). All 140 patients had quantitative cholescintigraphy after normalization of liver function and were followed on a regular basis with liver biochemistry, sonography, and/or computed tomography. Endoscopic retrograde cholangiography was also performed if a recurrent biliary problem was suspected.
After a median 43 months (range 23 to 80) of follow-up, 5 patients in group A developed bile duct stones whereas 12 patients in group B had recurrent stones; 4 patients in group A versus 6 patients in group B had recurrent biliary symptoms. One patient in group A and 5 patients in group B with recurrent biliary stones were without symptoms. In group B, the age, gender, diameter of the bile duct, preexisting cholelithiasis, abnormal filling of the gallbladder on quantitative cholescintigraphy, and presence of juxtapapillary diverticulum were not found to be the significant factors affecting the recurrence of biliary symptoms or stones. Endoscopic removal of recurrent biliary stones was successful in all patients. Three patients in group B underwent cholecystectomy after abatement of symptoms.
Elective cholecystectomy after endoscopic sphincterotomy does not reduce the incidence of recurrent biliary complications.
内镜括约肌切开术后胆囊完整被认为是复发性胆道并发症的一个潜在危险因素。这项非随机前瞻性研究的目的是调查内镜括约肌切开术后尽早行胆囊切除术是否能预防胆道并发症的复发。
1991年1月至1995年10月，140例胆囊完整的患者接受了内镜括约肌切开术以清除胆管结石。在这140例患者中，46例在括约肌切开术后不久接受了择期胆囊切除术（A组），94例未接受（B组）。所有140例患者在肝功能恢复正常后均进行了定量胆囊闪烁显像，并定期进行肝脏生化检查、超声检查和/或计算机断层扫描。如果怀疑有复发性胆道问题，也会进行内镜逆行胆管造影。
中位随访43个月（范围23至80个月）后，A组有5例患者发生胆管结石，而B组有12例患者结石复发；A组有4例患者与B组有6例患者出现复发性胆道症状。A组1例患者和B组5例有复发性胆石症的患者无症状。在B组中，年龄、性别、胆管直径、既往胆结石、定量胆囊闪烁显像时胆囊充盈异常以及乳头旁憩室的存在均未被发现是影响胆道症状或结石复发的显著因素。所有患者内镜下取出复发性胆管结石均成功。B组3例患者在症状缓解后接受了胆囊切除术。
内镜括约肌切开术后择期胆囊切除术并不能降低复发性胆道并发症的发生率。
