Zhao Xiao-Yu, Chen Ming, Wang Gang, Cui Long, Xu Zhi, Hou Chun-Sheng, Wang Li-Xin, Zhang Ling-Fu, Ling Xiao-Feng
Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Department of Radiology, Peking University Third Hospital, Beijing 100191, China.
World J Gastrointest Surg. 2025 Jul 27;17(7):106712. doi: 10.4240/wjgs.v17.i7.106712.
Choledocholithiasis is a common benign disease of the biliary tract. We identified a particular type of choledocholithiasis characterized by sudden narrowing of the common bile duct at the site of impaction, which caused a marked increase in surgical difficulty and risk compared to treatment for typical choledocholithiasis. This phenomenon has not been described in previous studies.
To propose the ice-breaking sign and evaluate its influence on treatment strategies for choledocholithiasis.
Using a retrospective case-control study design, patients who were diagnosed with common bile duct stones and admitted to the Emergency Department of Peking University Third Hospital between January 2018 and December 2023 were included. Propensity score matching was used to match cases and controls. Univariate analysis was conducted to assess the differences in clinical data between the two groups of patients.
There were no significant differences in the baseline data between the two groups, except for higher incidence of jaundice, alkaline phosphatase and total bilirubin in the ice-breaking sign group. Compared to the control group, the ice-breaking sign group had lower success rates for endoscopic retrograde cholangiopancreatography (25.0% 81.8%, = 0.006) and laparoscopic common bile duct exploration (69.4% 93.8%, = 0.007), longer operation time (148.04 ± 60.55 minutes 106.15 ± 35.21 minutes, = 0.001), higher likelihood of T-tube placement (62.2% 31.3%, = 0.016) and using lithotripsy techniques during surgery (29.7% 0%, = 0.001), more intraoperative bleeding [25.0 (20.0-50.0) mL 10.0 (10.0-20.0) mL, < 0.001] and longer postoperative hospital stay [6.50 (5.0-9.0) days 5.50 (3.0-6.50) days, = 0.002]. The ice-breaking sign group showed significantly more dilatation in the proximal than distal bile duct.
The ice-breaking sign, a newly identified radiological phenomenon, may influence therapeutic decisions in choledocholithiasis, suggesting laparoscopic common bile duct exploration as the preferred approach over endoscopic retrograde cholangiopancreatography in patients exhibiting this sign.
胆总管结石是一种常见的胆道良性疾病。我们发现了一种特殊类型的胆总管结石，其特征是在结石嵌顿部位胆总管突然变窄，与典型胆总管结石的治疗相比，这导致手术难度和风险显著增加。此前的研究尚未描述过这种现象。
提出“破冰征”并评估其对胆总管结石治疗策略的影响。
采用回顾性病例对照研究设计，纳入2018年1月至2023年12月期间在北京大学第三医院急诊科确诊为胆总管结石并入院的患者。采用倾向得分匹配法对病例和对照进行匹配。进行单因素分析以评估两组患者临床数据的差异。
两组患者的基线数据无显著差异，但“破冰征”组的黄疸、碱性磷酸酶和总胆红素发生率较高。与对照组相比，“破冰征”组的内镜逆行胰胆管造影成功率较低（25.0%对81.8%，P = 0.006），腹腔镜胆总管探查成功率较低（69.4%对93.8%，P = 0.007），手术时间较长（148.04±60.55分钟对106.15±35.21分钟，P = 0.001），放置T管的可能性较高（6..2%对31.3%，P = 0.016），术中使用碎石技术的可能性较高（29.7%对0%，P = 0.001），术中出血量较多[25.0（20.0-50.0）mL对10.0（10.0-20.0）mL，P < 0. = 001]，术后住院时间较长[6.50（5.0-9.0）天对5.50（3.0-6.50）天，P = 0.002]。“破冰征”组近端胆管的扩张明显大于远端胆管。
“破冰征”是一种新发现的影像学现象，可能影响胆总管结石的治疗决策，提示在出现该征象的患者中，腹腔镜胆总管探查是比内镜逆行胰胆管造影更优选的方法。
