May G R, Shaffer E H
J Clin Gastroenterol. 1991 Apr;13(2):125-8. doi: 10.1097/00004836-199104000-00002.
Since the introduction of endoscopic sphincterotomy approximately 15 years ago, the indications for this procedure have expanded. Currently endoscopic sphincterotomy is the procedure of choice for management of retained common bile duct stones following cholecystectomy. It is also being used more frequently for choledocholithiasis with an intact gallbladder in high-risk patients and in some patients with acute gallstone pancreatitis. In patients recovering from an episode of gallstone pancreatitis, standard practice has been subsequent cholecystectomy with possible exploration of the common bile duct. To avoid surgery in high-risk patients, we propose that an elective endoscopic sphincterotomy may be a reasonable therapeutic option regardless of whether common bile duct stones are present at the time of ERCP. A prospective trial is needed to examine this issue since to date there is no literature on endoscopic sphincterotomy in the absence of choledocholithiasis for gallstone pancreatitis in patients with intact gallbladders.
自从大约15年前引入内镜下括约肌切开术以来，该手术的适应证已经扩大。目前，内镜下括约肌切开术是胆囊切除术后胆总管残留结石治疗的首选方法。它也越来越多地用于高危患者以及一些急性胆石性胰腺炎患者的完整胆囊合并胆总管结石的情况。在从胆石性胰腺炎发作中恢复的患者中，标准做法是随后进行胆囊切除术，并可能探查胆总管。为了避免高危患者进行手术，我们建议，无论在ERCP时是否存在胆总管结石，选择性内镜下括约肌切开术可能是一种合理的治疗选择。由于迄今为止尚无关于完整胆囊的胆石性胰腺炎患者在无胆总管结石情况下进行内镜下括约肌切开术的文献，因此需要进行一项前瞻性试验来研究这个问题。
