Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
Eur J Gastroenterol Hepatol. 2009 Apr;21(4):466-70.
Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD.
Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications.
Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), whereas re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively.
The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.
未经治疗的胆囊原位结石患者在接受内镜乳头球囊扩张（EPBD）和胆管结石取出术后，发生晚期胆道并发症的风险很高。关于这些患者在胆管结石复发和急性胆囊炎后短期和长期结果的数据很少。本研究旨在评估 EPBD 后胆囊原位结石患者晚期胆道并发症的结果。
56 例发生晚期胆道并发症的患者，包括胆管结石复发（n=43）和急性胆囊炎（n=13），在我们的机构接受治疗。我们调查了晚期胆道并发症治疗后的短期和长期结果。
通过反复 EPBD 单独成功去除 43 例患者中的 38 例（88%）的复发性胆管结石。两次 EPBD 后发生胰腺炎 2 例（5%）。通过 EPBD 成功取出胆管结石后，16 例接受胆囊切除术的患者无一例发生晚期胆道并发症（平均随访 5.2 年），而 21 例胆囊结石仍保留原位的患者中有 3 例（14%）再次发生胆管结石复发（平均随访 4.4 年）（P=0.1148）。再次复发的胆管结石经内镜治疗成功。8 例未行胆囊切除术治疗急性胆囊炎的患者中，1 例发生胆囊炎复发，保守治疗。
当伴有胆囊结石的患者行胆囊切除术时，晚期胆道并发症的长期结果是有利的。当胆囊结石保留原位时，会出现复发性胆管结石，但可以通过内镜治疗。
