Dept. of Surgery, Central Hospital of Central Finland, Finland.
Dept. of Surgery, Central Hospital of Central Finland, Finland.
Int J Surg. 2017 Jul;43:107-111. doi: 10.1016/j.ijsu.2017.05.064. Epub 2017 May 31.
Wait-and-see policy after endoscopic sphincterotomy (ES) for common bile duct (CBD) stones in patients with concomitant gallbladder stones may lead to recurrent biliary complications. The aim of this study was to assess the short and long-term results of wait-and-see policy in patients with intact gallbladder after endoscopic clearance of CBD stones.
From January 1999 to December 2014 a total of 181 consecutive patients with intact gallbladder underwent ES for CBD stones. The main measures of outcome were long-term biliary complications, biliary related mortality, CBD stone recurrence and need for surgical interventions. Secondary outcomes were 30-day mortality and 30-day morbidity. Clinical data were retrospectively collected from hospital records and from the National Registry of Death.
During the median follow-up of 3.9 years (IQR 1.6-6.6) late biliary complications were observed in 24 (13.8%) patients. Cumulative biliary related morbidity at 3 and 5 years was 7.6% and 10.8%, respectively. CBD stone recurrence was observed in 9 (5.2%) patients. On-demand cholecystectomy was performed in 6 (3.3%) patients. 30-day mortality was 3.9% and 30-day morbidity 9.4%. Overall cumulative mortality rate at 3 and 5 years after ES was 31.4% and 49.7%, respectively. Long-term biliary related mortality was 1.7%. No significant difference in long term complications or biliary mortality was observed between patients< 75 or ≥75 years of age.
Prophylactic cholecystectomy after ES has been shown to reduce mortality even in high-risk patients. In our series late biliary related mortality and morbidity were relatively low, because a considerable number of patients died from non-biliary related causes.However, most biliary-related events seem to occur evenly during the follow-up after ES. A prompt risk assesment and consideration of surgical treatment during index admission may prevent late biliary -related complications.
内镜下括约肌切开术（ES）治疗伴有胆囊结石的胆总管（CBD）结石后，采取等待观察的策略可能会导致复发性胆道并发症。本研究旨在评估在 ES 清除 CBD 结石后胆囊完整的患者中采取等待观察策略的短期和长期结果。
从 1999 年 1 月至 2014 年 12 月，共有 181 例胆囊完整的连续患者接受了 ES 治疗 CBD 结石。主要结局指标是长期胆道并发症、胆道相关死亡率、CBD 结石复发和需要手术干预的情况。次要结局指标是 30 天死亡率和 30 天发病率。临床数据从医院记录和国家死亡登记处回顾性收集。
在中位随访 3.9 年（IQR 1.6-6.6）期间，24 例（13.8%）患者出现晚期胆道并发症。3 年和 5 年时累积胆道相关发病率分别为 7.6%和 10.8%。9 例（5.2%）患者出现 CBD 结石复发。按需行胆囊切除术 6 例（3.3%）。30 天死亡率为 3.9%，30 天发病率为 9.4%。ES 后 3 年和 5 年的总累积死亡率分别为 31.4%和 49.7%。长期胆道相关死亡率为 1.7%。年龄<75 岁或≥75 岁的患者之间，长期并发症或胆道死亡率无显著差异。
ES 后预防性胆囊切除术已被证明可降低死亡率，即使在高危患者中也是如此。在我们的系列研究中，晚期胆道相关的死亡率和发病率相对较低，因为相当一部分患者死于非胆道相关原因。然而，大多数胆道相关事件似乎在 ES 后随访期间均匀发生。在入院时及时进行风险评估并考虑手术治疗可能会预防晚期胆道相关并发症。
Zotero 插件