Ramirez P, Parrilla P, Bueno F S, Abad Y M, Muelas M S, Candel M F, Robles R, Lujan J, Pellicer E
Department of Surgery, Virgen Arrixaca Hospital, University of Murcia, Spain.
Surg Gynecol Obstet. 1993 Mar;176(3):246-50.
The present article analyzes the indications for sphincterotomy in the Surgical Department of the University of Murcia, postoperative morbidity and mortality and the long term clinical situation of the patient after a follow-up period averaging 5.8 years. During a ten year period, a total of 2,610 patients underwent operation for biliary lithiasis, with exploratory choledochotomy indicated in 591 (22.6 percent). Surgical exploration of the bile duct finished with sphincterotomy in 135 (22.9 percent); 52 percent of these patients were less than 60 years old. The most frequent preoperative diagnosis was choledocholithiasis (33.3 percent) and cholelithiasis with crises of acute pancreatitis (30.3 percent). If we divide the ten years of the study into two five year periods, we noted a statistically significant decrease (p < 0.001) in the percentage of sphincterotomies compared with the number of choledochotomies performed during the second period. The rate of intra-abdominal complications was 5.1 percent; four intra-abdominal abscesses, one hemorrhaging at the level of the sphincterotomy and two instances of postoperative pancreatitis. Mortality in the series was 1.4 percent (two patients)--one with postoperative pancreatitis that developed torpidly and one with pulmonary embolism. Six years after the operation, 72.9 percent of the patients are still asymptomatic and the remaining patients have some type of symptoms--15.8 percent presented with dyspeptic syndrome; 2.0 percent had crises of colicky pain, and 5.9 percent required hospital admission for cholangitis. All of the patients with symptoms underwent endoscopy and ultrasonographic exploration of the bile duct. There were no pathologic findings in the biliary tree of patients who had dyspeptic syndrome or colicky pain, and all of the patients with cholangitis had a papillary stenosis and required endoscopic sphincterotomy or reoperation.
本文分析了穆尔西亚大学外科进行括约肌切开术的适应症、术后发病率和死亡率，以及在平均5.8年的随访期后患者的长期临床情况。在十年期间，共有2610例患者接受了胆石症手术，其中591例（22.6%）需要进行胆总管探查术。135例（22.9%）患者在胆管手术探查后进行了括约肌切开术；这些患者中有52%年龄小于60岁。最常见的术前诊断是胆总管结石（33.3%）和伴有急性胰腺炎发作的胆结石（30.3%）。如果将研究的十年分为两个五年期，我们注意到与第二期进行的胆总管切开术数量相比，括约肌切开术的百分比有统计学显著下降（p<0.001）。腹腔内并发症发生率为5.1%；有4例腹腔内脓肿、1例括约肌切开处出血和2例术后胰腺炎。该系列的死亡率为1.4%（2例患者）——1例术后胰腺炎进展缓慢，1例发生肺栓塞。术后六年，72.9%的患者仍无症状，其余患者有某种类型的症状——15.8%表现为消化不良综合征；2.0%有绞痛发作，5.9%因胆管炎需要住院治疗。所有有症状的患者均接受了内镜检查和胆管超声探查。患有消化不良综合征或绞痛的患者胆管树未发现病理结果，所有胆管炎患者均有乳头狭窄，需要进行内镜括约肌切开术或再次手术。
