Li Zhe-Fu, Chen Xiao-Ping
Department of Hepatic Surgery Center, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Hepatobiliary Pancreat Dis Int. 2007 Feb;6(1):67-71.
The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly.
The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from 1 to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy, and 71 patients who had received choledochojejunostomy.
Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy and T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6+/-3.9 mm) than in group B (10.8+/-4.5 mm, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01).
Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recurrent lithiasis.
胆总管结石的复发率取决于疾病类型。本研究旨在探讨老年胆总管结石患者，尤其是原发性胆总管结石患者手术治疗后的结石复发情况，从而确定老年胆总管结石的最佳治疗方式。
根据193例门诊患者的记录计算胆总管结石的复发率，这些患者于1993年1月至2005年1月接受治疗，并进行了1至12年（平均6.7年）的随访。患者分为3组：81例行胆总管切开取石术及T管引流术，41例行胆总管十二指肠吻合术，71例行胆总管空肠吻合术。
由于41例行胆总管十二指肠吻合术的病例仅1例复发胆总管结石，因此对其余152例患者的复发率进行分析，将其分为两组：A组为结石复发组（13例），B组为未复发组（139例）。胆总管切开取石术及T管引流术后7例复发（7/81，8.6%），胆总管空肠吻合术后6例复发（6/71，8.5%）。这些手术的复发率高于胆总管十二指肠吻合术（1/41，2.4%，P<0.05）。此外，11例行胆总管切开取石术及T管引流术的原发性胆管结石患者中有4例复发（4/11，36.4%），34例行胆总管空肠吻合术的患者中有5例复发（5/34，14.7%）。这些手术的复发率高于胆总管十二指肠吻合术（1/39，2.6%，P<0.05）。A组胆总管直径（14.6±3.9mm）比B组（10.8±4.5mm，P<0.05）更宽。A组9例（69.2%）发现原发性胆管结石，B组36例（25.9%，P<0.01）发现原发性胆管结石。
对于患有原发性胆管结石的老年患者，应推荐胆总管十二指肠吻合术以预防术后结石复发。
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