Endoscopy Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam.
J Gastrointest Surg. 2010 Apr;14(4):688-96. doi: 10.1007/s11605-009-1131-0. Epub 2010 Jan 5.
Post-cholecystectomy clip migration (PCCM) is rare and can lead to complications which include clip-related biliary stones. Most have been reported as case reports. This study reviews cases of clip migration reported in the literatures.
Searches and reviews of the literatures from "PubMed," "EMBASE," and "Google Scholar" search engines using the keywords "clip migration" and "bile duct stones" were carried out. Eighty cases from 69 publications were identified but details for only 69 cases were available for the study.
The median age at presentations of PCCM was 60 years old (range, 31 to 88 years; female, 61.8%) and the median time from the initial cholecystectomy to clinical presentations was 26 months (range, 11 days to 20 years). Of primary surgeries, 23.2% was for complicated gallstones disease. The median number of clips placed during surgery was six (range, two to more than ten clips). Common diagnoses at presentations of PCCM were obstructive jaundice (37.7%), cholangitis (27.5%), biliary colic (18.8%), and acute pancreatitis (8.7%). The median number of migrated clip was one (range, one to six). Biliary dilatation and strictures were encountered in 74.1% and 28.6%, respectively. Of the 69 cases of PCCM-associated complications, 53 (77%) were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), 14 (20.2%) with surgery, and one (1.4%) with successful percutaneous transhepatic cholangiography treatment. One patient had spontaneous clearance of PCCM. There was no reported mortality related to PCCM.
PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP.
胆囊切除术后夹迁移（PCCM）很少见，但可能导致并发症，包括与夹子相关的胆管结石。大多数病例报告为病例报告。本研究回顾了文献中报道的夹迁移病例。
使用“PubMed”、“EMBASE”和“Google Scholar”搜索引擎搜索和回顾文献，关键词为“夹迁移”和“胆管结石”。共确定了 69 篇出版物中的 80 例，但只有 69 例的详细信息可供研究。
PCCM 出现的中位年龄为 60 岁（范围，31 至 88 岁；女性占 61.8%），从初次胆囊切除术到临床出现的中位时间为 26 个月（范围，11 天至 20 年）。在主要手术中，23.2%为复杂胆囊疾病。手术中放置的夹中位数为 6 个（范围，2 至 10 个以上）。PCCM 出现的常见诊断为阻塞性黄疸（37.7%）、胆管炎（27.5%）、胆绞痛（18.8%）和急性胰腺炎（8.7%）。迁移夹的中位数为 1 个（范围，1 至 6 个）。胆管扩张和狭窄分别占 74.1%和 28.6%。在 69 例 PCCM 相关并发症中，53 例（77%）经内镜逆行胰胆管造影（ERCP）成功治疗，14 例（20.2%）经手术治疗，1 例（1.4%）经经皮肝穿刺胆管造影治疗成功。1 例患者 PCCM 自行清除。无与 PCCM 相关的死亡报告。
PCCM 可随时发生，但通常在胆囊切除术后 2 年中位数发生。临床表现与原发性或继发性胆管结石相似。大多数可通过 ERCP 成功治疗。
