Altorfer J
Gastroenterologie-Zentrum Hirslanden, Zürich.
Praxis (Bern 1994). 1995 May 16;84(20):605-10.
Bile duct stones are associated with a high rate of severe complications such as bile duct obstruction, cholangitis and biliary pancreatitis; therefore, stones of the common bile duct should always be removed. Today the endoscopic sphincterotomy and stone removal are the therapy of choice. When the gallbladder is still present, the duct stones should be removed endoscopically before laparoscopic cholecystectomy. For difficult bile duct stones, various procedures like mechanical lithotripsy, intracorporeal shock wave lithotripsy (ISWL), intracorporeal laser lithotripsy (ILL) and extracorporeal shock wave lithotripsy (ESWL) have been shown to increase the success rate of duct clearance to up to 95 to 100%. Before laparoscopic cholecystectomy, an ERCP should be performed, if there is a history or repeated biliary colic pain, cholangitis or biliary pancreatitis, if on ultrasound the diameter of the common bile duct is greater than 6mm, or if there are signs of cholestasis in the laboratory. In acute cholangitis, urgent endoscopic sphincterotomy has been shown to decrease the morbidity and mortality rate compared to surgical interventions. In acute biliary pancreatitis, early sphincterotomy also decreases the rate of morbidity significantly.
胆管结石与胆管梗阻、胆管炎和胆源性胰腺炎等严重并发症的高发生率相关；因此，胆总管结石应始终予以清除。如今，内镜括约肌切开术和取石术是首选治疗方法。当胆囊仍然存在时，应在腹腔镜胆囊切除术之前通过内镜清除胆管结石。对于困难的胆管结石，诸如机械碎石术、体内冲击波碎石术（ISWL）、体内激光碎石术（ILL）和体外冲击波碎石术（ESWL）等各种方法已被证明可将胆管清除成功率提高至95%至100%。在腹腔镜胆囊切除术之前，如果有胆绞痛病史或反复胆绞痛、胆管炎或胆源性胰腺炎病史，超声显示胆总管直径大于6mm，或者实验室检查有胆汁淤积迹象，则应进行内镜逆行胰胆管造影（ERCP）。在急性胆管炎中，与手术干预相比，紧急内镜括约肌切开术已被证明可降低发病率和死亡率。在急性胆源性胰腺炎中，早期括约肌切开术也可显著降低发病率。
