Poon R T, Liu C L, Lo C M, Lam C M, Yuen W K, Yeung C, Fan S T, Wong J
Department of Surgery, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China.
Arch Surg. 2001 Jan;136(1):11-6. doi: 10.1001/archsurg.136.1.11.
The combined endoscopic and laparoscopic approach is safe and effective in managing gallstone cholangitis in the era of laparoscopic cholecystectomy (LC).
Retrospective case series.
University teaching hospital.
One hundred eighty-four consecutive patients with gallstone cholangitis treated between January 1995 and December 1998.
The main treatments were endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval LC. Open or laparoscopic common bile duct exploration (OCBDE or LCBDE) was used when ERCP or ES failed.
Success of various interventions, morbidity and mortality, and long-term incidence of recurrent biliary symptoms.
Endoscopic retrograde cholangiopancreatography was successful in 175 patients (95%), with bile duct stones found in 147 (84%). Endoscopic stone clearance by ES was achieved in 132 patients (90%). Morbidity rate after ERCP or ES was 4.0% (n = 7), and overall mortality rate from cholangitis was 1.6% (n = 3). After bile duct stone clearance, 82 patients underwent LC with a conversion rate of 9.8% (n = 8) and a morbidity rate of 3.6% (n = 3). Eighteen patients underwent OCBDE with a morbidity rate of 33% (n = 6), and 3 underwent LCBDE with 1 conversion and no morbidity. There was no operative mortality. Seventy-eight patients were managed conservatively after endoscopic clearance of bile duct stones. Follow-up data were available in 101 patients with cholecystectomy and 73 patients with gallbladder in situ. During a median follow-up of 24 months, recurrent biliary symptoms occurred in 5.9% (n = 6) and 25% (n = 18), respectively (P =.001). In both groups, the most common recurrent symptom was cholangitis (n = 5 and n = 14, respectively). Gallbladder in situ (risk ratio, 4.16; 95% confidence interval, 1.39-12.50; P =.01) and small-size papillotomy (risk ratio, 2.94; 95% confidence interval, 1. 07-8.10; P =.04) were significant risk factors for recurrent biliary symptoms.
Endoscopic sphincterotomy for biliary drainage and stone removal, followed by interval LC, is a safe and effective approach for managing gallstone cholangitis. Patients with gallbladder left in situ after ES have an increased risk of recurrent biliary symptoms. Laparoscopic cholecystectomy should be recommended after endoscopic management of cholangitis except in patients with prohibitive surgical risk.33333333333333333333333
在腹腔镜胆囊切除术（LC）时代，联合内镜和腹腔镜的方法在治疗胆囊结石性胆管炎方面是安全有效的。
回顾性病例系列研究。
大学教学医院。
1995年1月至1998年12月期间连续收治的184例胆囊结石性胆管炎患者。
主要治疗方法为内镜逆行胰胆管造影（ERCP）和内镜括约肌切开术（ES），随后进行择期LC。当ERCP或ES失败时，采用开腹或腹腔镜胆总管探查术（OCBDE或LCBDE）。
各种干预措施的成功率、发病率和死亡率，以及胆道症状复发的长期发生率。
175例患者（95%）ERCP成功，其中147例（84%）发现胆管结石。132例患者（90%）通过ES实现了内镜下结石清除。ERCP或ES后的发病率为4.0%（n = 7），胆管炎的总体死亡率为1.6%（n = 3）。胆管结石清除后，82例患者接受了LC，转换率为9.8%（n = 8），发病率为3.6%（n = 3）。18例患者接受了OCBDE，发病率为33%（n = 6），3例患者接受了LCBDE，1例转换，无发病率。无手术死亡。78例患者在内镜清除胆管结石后接受了保守治疗。101例行胆囊切除术患者和73例保留胆囊患者有随访数据。在中位随访24个月期间，胆道症状复发率分别为5.9%（n = 6）和25%（n = 18）（P =.001）。在两组中，最常见的复发症状是胆管炎（分别为n = 5和n = 14）。保留胆囊（风险比，4.16；95%置信区间，1.39 - 12.50；P =.01）和小切口乳头切开术（风险比，2.94；95%置信区间，1.07 - 8.10；P =.04）是胆道症状复发的显著危险因素。
内镜括约肌切开术用于胆道引流和结石清除，随后进行择期LC，是治疗胆囊结石性胆管炎的一种安全有效的方法。ES后保留胆囊的患者胆道症状复发风险增加。除手术风险过高的患者外，在内镜治疗胆管炎后应推荐行腹腔镜胆囊切除术。
