Yang Zhenzhen, Hong Junbo, Zhu Liang, Zhang Cheng, Zhou Xiaojiang, Li Guohua, Zhu Yong, Liu Zhijian, Zhou Xiaodong, Chen Youxiang
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Front Surg. 2023 Jan 6;9:1021395. doi: 10.3389/fsurg.2022.1021395. eCollection 2022.
Choledocholithiasis complicated with cholecystolithiasis is a common disease. This study explores a novel strategy, called ERCP-based transcystic gallbladder-preserving cholecystolithotomy, for the simultaneous removal of common bile duct stones and gallbladder stones.
From December 2018 to June 2021, all patients with cholecystolithiasis and common bile duct stones who met the criteria for gallbladder preservation in our hospital were included in the study and prospectively followed up.
We included 48 patients, including 20 patients with acute biliary pancreatitis. All patients successfully underwent ERCP to remove common bile duct stones. One patient had gallbladder perforation during gallbladder-preserving cholecystolithotomy. The guide wire successfully entered the gallbladder, and the transpapillary gallbladder metal-covered stent was successfully placed in 44 patients. The technical success rate was 91.67% (44/48). All stones were removed in 34 patients, for a clinical success rate of 77.27% (34/44). The total postoperative complication rate was 6.25% (3/48), with 2 cases of pancreatitis (4.17%) and 1 case of cholangitis (2.08%). Three patients were lost to follow-up. Among the 31 patients who were followed up for a mean of 27 months (6-40), 5 patients (16.13%) experienced gallstone recurrence. The recurrence rates at 12 months, 18 months, 24 months, 30 months and 36 months were 0%, 3.23%, 6.45%, 12.9%, and 16.13%, respectively.
For patients with cholecystolithiasis and common bile duct stones, ERCP-based transcystic gallbladder-preserving cholecystolithotomy without gallbladder incision can preserve gallbladder structure, and this procedure is safe and feasible for the protection of gallbladder function. The study was registered in the Chinese Clinical Trial Registry, and the registry number is ChiCTR1900028006.
胆总管结石合并胆囊结石是一种常见疾病。本研究探索了一种新策略，即基于内镜逆行胰胆管造影术（ERCP）的经胆囊保留胆囊取石术，用于同时清除胆总管结石和胆囊结石。
2018年12月至2021年6月，我院所有符合胆囊保留标准的胆囊结石和胆总管结石患者均纳入本研究并进行前瞻性随访。
我们纳入了48例患者，其中20例患有急性胆源性胰腺炎。所有患者均成功接受ERCP清除胆总管结石。1例患者在保留胆囊取石术中发生胆囊穿孔。导丝成功进入胆囊，44例患者成功置入经乳头胆囊金属覆膜支架。技术成功率为91.67%（44/48）。34例患者结石全部清除，临床成功率为77.27%（34/44）。术后总并发症发生率为6.25%（3/48），其中胰腺炎2例（4.17%），胆管炎1例（2.08%）。3例患者失访。在平均随访27个月（6 - 40个月）的31例患者中，5例（16.13%）出现胆结石复发。12个月、18个月、24个月、30个月和36个月的复发率分别为0%、3.23%、6.45%、12.9%和16.13%。
对于胆囊结石合并胆总管结石患者，基于ERCP的经胆囊保留胆囊取石术无需切开胆囊，可保留胆囊结构，该手术对于保护胆囊功能安全可行。本研究已在中国临床试验注册中心注册，注册号为ChiCTR1900028006。
