Park Chi Young, Choi Sung Hoon, Kwon Chang-Il, Cho Jae Hee, Jang Sung Ill, Lee Tae Hoon, Han Joung-Ho, Jeong Seok, Ko Kwang Hyun
Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Ann Surg Treat Res. 2020 Dec;99(6):329-336. doi: 10.4174/astr.2020.99.6.329. Epub 2020 Nov 26.
Repeating endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent common bile duct (CBD) stones is problematic in many ways. Choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) are 2 surgical treatment options for recurrent CBD stones, and each has different advantages and disadvantages. The aim of this study was to compare the 2 surgical options in terms of the recurrence rate of CBD stones after surgical treatment.
This retrospective multicenter study included all patients who underwent surgical treatment due to recurrent CBD stones that were not effectively controlled by medical treatment and repeated ERCP between January 2006 and March 2015. We collected data from chart reviews and medical records. A recurrent CBD stone was defined as a stone found 6 months after the complete removal of a CBD stone by ERCP. Patients who underwent surgery for other reasons were excluded.
A total of 27 patients were enrolled in this study. Six patients underwent CDS, and 21 patients underwent CJS for the rescue treatment of recurrent CBD stones. The median follow-up duration was 290 (180-1,975) days in the CDS group and 1,474 (180-6,560) days in the CJS group (P = 0.065). The postoperative complications were similar and tolerable in both groups (intestinal obstruction; 2 of 27, 7.4%; 1 in each group). CBD stones recurred in 4 patients after CDS (4 of 6, 66.7%), and 3 patients after CJS (3 of 21, 14.3%) (P = 0.010).
CJS may be a better surgical option than CDS for preventing further stone recurrence in patients with recurrent CBD stones.
对于复发性胆总管结石患者，重复进行内镜逆行胰胆管造影术（ERCP）在很多方面存在问题。胆总管十二指肠吻合术（CDS）和胆总管空肠吻合术（CJS）是复发性胆总管结石的两种手术治疗选择，且各有不同优缺点。本研究的目的是比较这两种手术方式在手术治疗后胆总管结石复发率方面的差异。
这项回顾性多中心研究纳入了2006年1月至2015年3月期间因复发性胆总管结石接受手术治疗且药物治疗无法有效控制、并接受过重复ERCP的所有患者。我们从病历审查和医疗记录中收集数据。复发性胆总管结石定义为通过ERCP完全清除胆总管结石6个月后发现的结石。因其他原因接受手术的患者被排除。
本研究共纳入27例患者。6例患者接受了CDS，21例患者接受了CJS用于复发性胆总管结石的挽救治疗。CDS组的中位随访时间为290（180 - 1975）天，CJS组为1474（180 - 6560）天（P = 0.065）。两组术后并发症相似且均可耐受（肠梗阻；27例中有2例，7.4%；每组各1例）。CDS术后4例患者胆总管结石复发（6例中的4例，66.7%），CJS术后3例患者复发（21例中的3例，14.3%）（P = 0.010）。
对于复发性胆总管结石患者，为预防结石进一步复发，CJS可能是比CDS更好的手术选择。
