Wang Chi-Chih, Tseng Ming-Hseng, Wu Sheng-Wen, Yang Tzu-Wei, Chen Hsuan-Yi, Sung Wen-Wei, Su Chang-Cheng, Wang Yao-Tung, Lin Chun-Che, Tsai Ming-Chang
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan.
World J Gastrointest Oncol. 2020 Dec 15;12(12):1381-1393. doi: 10.4251/wjgo.v12.i12.1381.
Cholangiocarcinoma is a disease with a high mortality rate. Our previous study revealed that cholelithiasis patients who undergo endoscopic sphincterotomy (ES)/endoscopic papillary balloon dilatation are at a higher risk for subsequent cholangiocarcinoma than cholelithiasis patients who undergo cholecystectomy.
To clarify the relationship between recurrent biliary events and subsequent cholangiocarcinoma risk in choledocholithiasis patients.
From one million random cases in the Taiwan National Health Insurance Research Database 2004-2011, we selected symptomatic choledocholithiasis patients older than 18 years who were admitted from January 2005 to December 2009 (study group). Cases for a control group were defined as individuals who had never been diagnosed with cholelithiasis, matched by sex and age in a 1:3 ratio. The study group was further divided into ES/endoscopic papillary balloon dilatation, both ES/endoscopic papillary balloon dilatation and cholecystectomy, and no intervention groups.
We included 2096 choledocholithiasis patients without previous intervention or cholangiocarcinoma. A total of 12 (2.35%), 11 (0.74%), and 1 (1.00%) subsequent cholangiocarcinoma cases were diagnosed among 511 ES/endoscopic papillary balloon dilatation patients, 1485 patients with no intervention, and 100 ES/endoscopic papillary balloon dilatation and cholecystectomy patients, respectively. The incidence rates of recurrent biliary event were 527.79/1000 person-years and 286.69/1000 person-years in the subsequent cholangiocarcinoma and no cholangiocarcinoma group, showing a high correlation between subsequent cholangiocarcinoma risk and recurrent biliary events.
Choledocholithiasis patients who undergo further cholecystectomy after ES/endoscopic papillary balloon dilatation have decreased subsequent cholangiocarcinoma risk due to reduced recurrent biliary events.
胆管癌是一种死亡率很高的疾病。我们之前的研究表明，接受内镜括约肌切开术（ES）/内镜乳头球囊扩张术的胆石症患者比接受胆囊切除术的胆石症患者后续发生胆管癌的风险更高。
阐明胆总管结石患者复发性胆管事件与后续胆管癌风险之间的关系。
从2004 - 2011年台湾国民健康保险研究数据库中的100万随机病例中，我们选取了2005年1月至2009年12月入院的18岁以上有症状的胆总管结石患者（研究组）。对照组病例定义为从未被诊断为胆石症的个体，按1:3的性别和年龄匹配。研究组进一步分为ES/内镜乳头球囊扩张术组、ES/内镜乳头球囊扩张术和胆囊切除术组以及未干预组。
我们纳入了2096例既往未接受干预或胆管癌的胆总管结石患者。在511例ES/内镜乳头球囊扩张术患者、1485例未干预患者和100例ES/内镜乳头球囊扩张术和胆囊切除术患者中，分别诊断出12例（2.35%）、11例（0.74%）和1例（1.00%）后续胆管癌病例。后续胆管癌组和无胆管癌组的复发性胆管事件发生率分别为527.79/1000人年和286.69/1000人年，表明后续胆管癌风险与复发性胆管事件之间存在高度相关性。
ES/内镜乳头球囊扩张术后接受进一步胆囊切除术的胆总管结石患者，由于复发性胆管事件减少，后续胆管癌风险降低。
