Saharia P C, Zuidema G D, Cameron J L
Ann Surg. 1977 May;185(5):598-604. doi: 10.1097/00000658-197705000-00013.
Thirty patients were identified as having primary common duct stones. Criteria for diagnosis included at least a two year symptom free interval following cholecystectomy; soft, light brown stones or sludge present in the common duct; and the absence of a long cystic duct remnant or a biliary stricture from the previous surgery. The average age of the 30 patients was 66 years. The interval between cholecystectomy and the diagnosis of primary common duct stones averaged 12 years. Acute cholangitis was a frequent mode of presentation. At the time of surgery the bile duct was often dilated out of proportion to the serum bilirubin. In only one of the 30 patients was ampullary stenosis present. Twenty-six of the 30 patients had only stone extraction and insertion of a T tube for treatment of their primary common duct stones. Twenty-two of the 26 were followed for an average of four years and nine months with no evidence of recurrent stones in 82% (18/22). Four developed recurrent primary common duct stones one, five, five, and 7 years later. It is concluded that most patients with primary common duct stones do well after stone extraction alone.
30例患者被确诊为原发性胆总管结石。诊断标准包括胆囊切除术后至少有两年无症状期；胆总管内存在柔软、浅棕色结石或胆泥；且既往手术无长的胆囊管残余或胆管狭窄。这30例患者的平均年龄为66岁。胆囊切除与原发性胆总管结石诊断之间的间隔平均为12年。急性胆管炎是常见的表现形式。手术时胆管扩张程度常与血清胆红素水平不成比例。30例患者中仅1例存在壶腹狭窄。30例患者中有26例仅接受了结石取出及T管置入术来治疗原发性胆总管结石。26例中的22例平均随访4年9个月，82%（18/22）无结石复发证据。4例分别在1年、5年、5年和7年后出现复发性原发性胆总管结石。结论是大多数原发性胆总管结石患者仅行结石取出术后效果良好。
