Schreurs W H, Juttmann J R, Stuifbergen W N H M, Oostvogel H J M, van Vroonhoven T J M V
Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.
Surg Endosc. 2002 Jul;16(7):1068-72. doi: 10.1007/s00464-001-9104-8. Epub 2002 May 3.
Common bile duct stones are still a frequent problem. Although new diagnostic and therapeutic techniques are continually being development, they remain poorly defined. Therefore, we decided to evaluate our standard method of diagnosing and treating common bile duct stones. The aim of the study was to determine the short- and long-term results of this method.
Between 1985 and 1995, 552 consecutive patients (200 men and 352 women; median age, 69 years) underwent endoscopic retrograde cholangiography (ERC) because of suspected common bile duct stones. If stones were detected, they were treated endoscopically, if possible. The results and complications of this policy were recorded. Patients were followed 1-13 years after undergoing ERC and endoscopic sphincterotomy (ES). Long-term results and complications during this period were also recorded.
ERC was attempted in 552 patients and succeeded in 510 patients (92%): ES was attempted in 315 patients and failed in five (98%). Duct clearance was done in 271 patients; in 26 of these patients, symptoms disappeared spontaneously. Ten patients underwent common bile duct exploration. Complications occurred in 46 patients (8.3%). Mortality was 0.4%, hemorrhage occurred in 3.6%, pancreatitis in 1.4%, sepsis and cholangitis also in 1.4%, and the lithotripter basket became impacted in four patients (0.8%), necessitating to common bile duct exploration. During follow-up, 45 patients (8%) returned, 35 with recurrent stones, five with cholangitis, two with stenosis of the papilla of Vater, and one with biliary pancreatitis. In 35 cases, complications were treated endoscopically, common bile duct exploration was performed in five cases, and symptoms disappeared spontaneously in five cases.
ERC is a safe and reliable way of diagnosing common bile duct stones, and ES is a very efficient way of treating them. Morbidity and mortality are low, and the long-term results are very good.
胆总管结石仍是一个常见问题。尽管新的诊断和治疗技术不断发展，但对其仍缺乏明确的定义。因此，我们决定评估我们诊断和治疗胆总管结石的标准方法。本研究的目的是确定该方法的短期和长期结果。
1985年至1995年间，552例连续患者（200例男性和352例女性；中位年龄69岁）因疑似胆总管结石接受了内镜逆行胆管造影（ERC）。如果检测到结石，尽可能通过内镜进行治疗。记录该策略的结果和并发症。患者在接受ERC和内镜括约肌切开术（ES）后随访1至13年。在此期间的长期结果和并发症也进行了记录。
552例患者尝试进行ERC，510例成功（92%）；315例患者尝试进行ES，5例失败（98%）。271例患者实现了胆管清除；其中26例患者症状自行消失。10例患者接受了胆总管探查。46例患者（8.3%）出现并发症。死亡率为0.4%，出血发生率为3.6%，胰腺炎发生率为1.4%，败血症和胆管炎发生率也为1.4%，碎石篮在4例患者（0.8%）中发生嵌顿，需要进行胆总管探查。随访期间，45例患者（8%）复诊，35例为复发性结石，5例为胆管炎，2例为 Vater乳头狭窄，1例为胆源性胰腺炎。35例患者的并发症通过内镜治疗，5例进行了胆总管探查，5例症状自行消失。
ERC是诊断胆总管结石的一种安全可靠的方法，ES是治疗胆总管结石的一种非常有效的方法。发病率和死亡率较低，长期效果非常好。
