Hill J, Martin D F, Tweedle D E
Department of Surgery, University Hospital of South Manchester, UK.
Br J Surg. 1991 May;78(5):554-7. doi: 10.1002/bjs.1800780512.
There is controversy concerning the subsequent clinical course of patients whose gallbladder is left in situ following successful endoscopic removal of stones from their common bile ducts. A total of 191 patients (median age 76 years) were reviewed between 12 and 100 months (mean 38 months) after endoscopic sphincterotomy. Ten patients (5.2 per cent) had symptoms requiring cholecystectomy which was uneventful, nine in the first year. Cholangitis at presentation or failure to fill the gallbladder by endoscopic retrograde cholangiography were not helpful in identifying these patients. Forty-nine (25.6 per cent) patients died during the review period from non-biliary pathology (usually cardiovascular). Elective cholecystectomy is not required in elderly patients with symptomatic bile duct stones if the common bile duct can be cleared of stones after endoscopic sphincterotomy.
对于成功进行内镜下胆总管结石取出术后胆囊仍保留原位的患者，其后续临床病程存在争议。在内镜括约肌切开术后12至100个月（平均38个月）对总共191例患者（中位年龄76岁）进行了回顾。10例患者（5.2%）出现需要行胆囊切除术的症状，手术过程顺利，其中9例在第一年。就诊时的胆管炎或内镜逆行胆管造影未能充盈胆囊对识别这些患者并无帮助。49例（25.6%）患者在回顾期内因非胆道病变（通常为心血管疾病）死亡。对于有症状性胆管结石的老年患者，如果在内镜括约肌切开术后胆总管结石能够清除，则无需择期行胆囊切除术。
