Tsai Wei-Lun, Lai Kwok-Hung, Lin Chiun-Ku, Chan Hoi-Hung, Lo Ching-Chu, Hsu Ping-I, Chen Wen-Chi, Cheng Jin-Shiung, Lo Gin-Ho
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang Ming University, Taiwan, China.
World J Gastroenterol. 2005 Jul 21;11(27):4246-9. doi: 10.3748/wjg.v11.i27.4246.
Endoscopic sphincterotomy (ES) is a well-established therapeutic modality for the removal of common bile duct (CBD) stones. After ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and after ES and its clinical significance in Chinese patients.
From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared (IR) spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.
In the initial 266 stone samples, 217 (82%) were bilirubinate stones, 42 (16%) were cholesterol stones, 3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones (66+/-13 years vs 56+/-17 years, P = 0.001). In the 44 recurrent stone samples, 38 (86%) were bilirubinate stones, 3 (7%) were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained, 23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.
Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients. The composition of CBD stones may be different from initial stones after ES.
内镜括约肌切开术（ES）是一种成熟的治疗胆总管（CBD）结石的方法。ES术后仍有大约10%的患者会出现胆总管结石复发。本研究旨在调查中国患者ES术前、术后胆总管结石的成分及其临床意义。
1996年1月至2003年12月，735例胆总管结石患者在高雄荣民总医院接受了ES治疗，其中266例患者的结石标本被送去分析。75例患者出现胆总管结石复发，44例患者的结石标本被送去分析。通过红外光谱法分析结石成分，并根据主要成分将其分为胆固醇结石或胆红素结石。对临床数据进行分析。
在最初的266个结石样本中，217个（82%）为胆红素结石，42个（16%）为胆固醇结石，3个为碳酸钙结石，4个为胆固醇与胆红素混合结石。胆红素结石患者的年龄显著大于胆固醇结石患者（66±13岁 vs 56±17岁，P = 0.001）。在44个复发结石样本中，38个（86%）为胆红素结石，3个（7%）为胆固醇结石，3个为胆固醇与胆红素混合结石。27例患者可同时获得初始结石和复发结石标本，23例患者初始为胆红素结石，复发时2例变为胆固醇结石。在4例初始为胆固醇结石的患者中，3例复发时为胆红素结石，1例复发时仍为胆固醇结石。
胆红素结石是中国患者初始或复发胆总管结石的主要成分。ES术后胆总管结石的成分可能与初始结石不同。
