Steed H, Lau K, Glass R, Durkin D, Deakin M, Green J R B
Department of Gastroenterology, University Hospital North Staffordshire, Stoke-on-Trent, Staffordshire, UK.
Department of Hepatobiliary Surgery, University Hospital North Staffordshire, Stoke-on-Trent, Staffordshire, UK.
Frontline Gastroenterol. 2014 Jul;5(3):161-166. doi: 10.1136/flgastro-2013-100391. Epub 2014 Jan 8.
To examine the outcome of endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones.
A retrospective review of 100 consecutive ERCPs performed for CBD stones.
100 ERCPs were performed on 84 patients with a median cohort age of 77. Completion in this cohort, as defined by duct clearance, was achieved in 65% of cases. Completion rates fell rapidly after two ERCPs. 33% of the cohort had small stones <10 mm, and 67% had stones >10 mm. Size, but not number of stones, affected the completion rate and frequency of complications (16%). Presence of periampullary diverticulum did not affect completion or complication rates. MR cholangiopancreatography (MRCP) had a 90% sensitivity for detecting CBD stones compared with 56% for CT.
ERCP remains a high-risk procedure with a significant complication rate when performed to deal with CBD stones. MRCP should be the second choice of investigation for CBD stones. This cohort had an unusually high number of larger stones at ERCP of 67% compared with other published UK cohorts of 8%, and this was reflected in the completion and complication rate.
探讨内镜逆行胰胆管造影术（ERCP）治疗胆总管结石的效果。
对连续100例因胆总管结石行ERCP的病例进行回顾性研究。
84例患者接受了100次ERCP，队列中位年龄为77岁。根据胆管清除情况定义，该队列中65%的病例完成了治疗。两次ERCP后完成率迅速下降。队列中33%的患者有<10 mm的小结石，67%的患者结石>10 mm。结石大小而非数量影响完成率和并发症发生率（16%）。壶腹周围憩室的存在不影响完成率或并发症发生率。磁共振胰胆管造影（MRCP）检测胆总管结石的敏感性为90%，而CT为56%。
ERCP在处理胆总管结石时仍是一项高风险操作，并发症发生率较高。MRCP应作为胆总管结石检查的第二选择。与英国其他已发表队列中8%的大结石比例相比，该队列在ERCP时大结石比例异常高，达67%，这在完成率和并发症发生率中有所体现。
