Abdelmajid Khnissi, Houssem Harbi, Rafik Ghrissi, Jarrar Mohamed S, Fehmi Hamila
Department of General Surgery, Professor Rached Letaief at Farhat Hached Hospital, Sousse, Tunisia.
N Am J Med Sci. 2013 Apr;5(4):288-92. doi: 10.4103/1947-2714.110438.
Nowadays, biliary-enteric drainage (BED) is regarded as a last resort or obsolete therapeutic method for common bile duct stone (CBDS) not only because of advances in minimally invasive therapeutic modalities but also due to fears of higher morbidity, cholangitis, and "sump" syndrome.
The present study aimed at evaluating the outcome of this procedure for choledocholithiasis.
It is a retrospective review of 51 patients who underwent open choledochoenterostomy for CBDS between January 2005 and December 2009.
About 40 women (78%) and 11 men underwent open BED (mean age 72 years). Indications were elderly patients (90%), multiple stones (54.9%) and unextractable calculi (15.4%). We performed 49 (96%) side to side choledochoduodenostomies, one end to side choledochoduodenostomy (CDS) and one end to side hepaticojejunostomy. The mortality rate was 3.9%. Overall morbidity was 12% with no biliary leakage. With a decline of 1-6 years, neither sump syndrome nor cholangiocarcinoma occurred.
Side-to-side CDS is a safe and highly effective therapeutic measure, even when performed on ducts less than 15 mm wide, provided a few technical requirements are respected. Patients experiencing relapsing cholangitis after BED should be closely monitored for the late development of biliary tract malignancies.
如今，胆管肠道引流术（BED）被视为胆总管结石（CBDS）的最后手段或过时的治疗方法，这不仅是因为微创治疗方式的进步，还因为担心其较高的发病率、胆管炎和“贮袋”综合征。
本研究旨在评估该手术治疗胆总管结石的效果。
这是一项对2005年1月至2009年12月间51例行开放性胆总管肠吻合术治疗CBDS患者的回顾性研究。
约40名女性（78%）和11名男性接受了开放性BED（平均年龄72岁）。适应证为老年患者（90%）、多发结石（54.9%）和无法取出的结石（15.4%）。我们进行了49例（96%）侧侧胆总管十二指肠吻合术、1例端端胆总管十二指肠吻合术（CDS）和1例端端肝管空肠吻合术。死亡率为3.9%。总体发病率为12%，无胆漏。随访1至6年，未发生贮袋综合征和胆管癌。
侧侧CDS是一种安全有效的治疗措施，即使在宽度小于15mm的胆管上进行，只要满足一些技术要求即可。BED术后出现复发性胆管炎的患者应密切监测胆道恶性肿瘤的晚期发展。
