Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Japan.
Dig Endosc. 2010 Apr;22(2):95-100. doi: 10.1111/j.1443-1661.2010.00936.x.
To assess long-term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis.
Retrospective review of clinical records of patients treated for choledocholithiasis and cholecystolithiasis from 1976 to 2006. Of 564 patients subjected to endoscopic papillotomy and endoscopic stone extraction, 522 patients (279 men, 243 women; mean age 66.2 years) were followed up and predisposing risk factors for late complications were analyzed.
The mean duration of follow up was 5.6 years. Cholecystitis and recurrent choledocholithiasis occurred in 39 (7.5%) and 60 (11.5%) patients, respectively. Cholecystitis, including one severe case, resolved with conservative treatment. Recurrent choledocholithiasis was successfully treated endoscopically except in one case. Pneumobilia was found to be a significant risk factor for cholecystitis (P = 0.019) and recurrent choledocholithiasis (P = 0.013). Biliary tract cancer occurred in 16 patients; gallbladder cancer in 13 and bile duct cancer in three. Gallbladder cancer developed within 2 years after endoscopic papillotomy in seven of the 13 patients (53.8%).
Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long-term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer.
评估单纯内镜下乳头切开术（endoscopic papillotomy，EP）而不随后行胆囊切除术治疗胆总管结石合并胆囊结石患者的长期疗效。
回顾性分析 1976 年至 2006 年间接受内镜下乳头切开术和内镜下取石治疗的胆总管结石合并胆囊结石患者的临床资料。564 例行 EP 和内镜下取石的患者中，522 例（279 例男性，243 例女性；平均年龄 66.2 岁）获得随访，分析导致晚期并发症的相关危险因素。
平均随访时间为 5.6 年。39 例（7.5%）患者发生胆囊炎，60 例（11.5%）患者发生胆总管结石复发。胆囊炎包括 1 例重症患者，经保守治疗后痊愈。胆总管结石复发除 1 例外均经内镜成功治疗。气胆征（pneumobilia）是胆囊炎（P = 0.019）和胆总管结石复发（P = 0.013）的显著危险因素。16 例患者发生胆道癌，其中胆囊癌 13 例，胆管癌 3 例。13 例患者中有 7 例（53.8%）在 EP 后 2 年内发生胆囊癌。
在本研究人群中，气胆征是胆囊炎和胆总管结石复发的唯一显著危险因素。关于长期预后，EP 是否导致胆道癌的发生尚不清楚。
