Yang Ye, Zhao Zeying, Wu Shuodong, Yao Dianbo
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
Ann Med. 2025 Dec;57(1):2440119. doi: 10.1080/07853890.2024.2440119. Epub 2024 Dec 13.
A high recurrence rate is undesirable after treatment of common bile duct (CBD) stones. A major risk factor identified for recurrence is that invasive techniques, including surgical or endoscopic treatments, will impair the biliary tract system either by direct incision of the CBD or by cutting or dilating the ampulla of Vater. During endoscopic treatment, two main assisted methods for lithotomy, sphincterotomy and papillary balloon dilation, can result in different degrees of damage to the structure and function of the sphincter of Oddi (SO), contributing to slowing of biliary excretion, cholestasis, biliary bacterial infection, and promotion of bile duct stone recurrence. In this review, the relationship between endoscopic lithotomy and structural impairment or functional abnormality of the SO will be summarized, and their relationship with the recurrence of CBD stones will also be analyzed. Further improvement of these endoscopic methods or exploration of some novel methods, such as endoscopic endoclip papilloplasty, temporary insertion of a self-expandable metal stent, and combined application of peroral cholangioscopy, may aid in providing more appropriate treatment for patients with choledocholithiasis, repair or protect the function and structure of SO, reduce or prevent the recurrence of bile duct stones, and improve patient outcomes.
胆总管结石治疗后出现高复发率是不理想的。已确定的复发主要危险因素是侵入性技术，包括手术或内镜治疗，会通过直接切开胆总管或切割或扩张十二指肠乳头而损害胆道系统。在内镜治疗期间，两种主要的取石辅助方法，即括约肌切开术和乳头球囊扩张术，可导致Oddi括约肌（SO）的结构和功能受到不同程度的损害，导致胆汁排泄减慢、胆汁淤积、胆道细菌感染，并促进胆管结石复发。在本综述中，将总结内镜取石与SO结构损伤或功能异常之间的关系，并分析它们与胆总管结石复发的关系。进一步改进这些内镜方法或探索一些新方法，如内镜夹闭乳头成形术、临时插入自膨式金属支架以及联合应用经口胆管镜检查，可能有助于为胆总管结石患者提供更合适的治疗，修复或保护SO的功能和结构，减少或预防胆管结石复发，并改善患者预后。
