Ozoux J P, De Calan L, Berton C, Favre J P, Dorval E, Brizon J
Service de Chirurgie Digestive et Thoracique, Hôpital Trousseau, CHU Tours.
Ann Chir. 1991;45(3):238-41.
Endoscopic sphincterotomy is the treatment of choice for stones in the common bile duct in patients with a high operative risk. However, when this modality is insufficient or fails, these patients need to be operated. The authors have operated 14 patients under these conditions. In addition to the cholecystectomy performed in 9 patients who still retained their gallbladder, the common bile duct was cleared in 3 cases and drained by means of choledochoduodenal anastomoses in 10 cases. Three patients developed complications and one of them died. Endoscopy and surgery appear to be complementary in this indication. Sphincterotomy should be proposed as first-line treatment as, even in the case of incomplete disobstruction, it enables high-risk patients to be operated under better conditions.
内镜下括约肌切开术是手术风险高的胆总管结石患者的首选治疗方法。然而，当这种方法不足或失败时，这些患者需要接受手术治疗。作者在这些情况下为14例患者进行了手术。除了对9例仍保留胆囊的患者进行胆囊切除外，3例患者的胆总管得到清理，10例患者通过胆总管十二指肠吻合术进行引流。3例患者出现并发症，其中1例死亡。在内镜检查和手术治疗这一适应症方面，二者似乎具有互补性。括约肌切开术应作为一线治疗方法，因为即使在解除梗阻不完全的情况下，它也能使高危患者在更好的条件下接受手术。
