Covarelli P, Cirocchi R, Pacifici A, Cagini L, Mazieri M, Goracci G, Fabbri C, Mosci F
Dipartimento di Chirurgia ed Emergenze Chirurgiche, Università degli Studi di Perugia.
G Chir. 1995 Nov-Dec;16(11-12):486-92.
Primary choledocholithiasis represents a quite unusual sequela of biliary tract surgery. Primary stones originate in the common bile duct and are soft, smooth, with a yellowish or brown-reddish colour, reproducing the shape of the duct in which arise. The Authors report a review of the cases observed in the division of General and Vascular Surgery-Department of Surgery and Surgical Emergencies of the University of Perugia. From January 1988 to December 1993, 577 laparotomic biliary tract operations were performed, and in 8 cases a re-operation was needed. Among the latter, particularly interesting were 2 cases of primary choledocholithiasis occurred in two patients with bilio-digestive anastomosis previously performed, i.e. two side-to-side Roux-en-Y or Braun loop choledochojejunostomies, respectively. Therefore, primary lithiasis following a choledochojejunostomy occurred when the bilio-digestive anastomoses were performed with the indication of a curative re-operation on the biliary tract. On the contrary, most choledochojejunostomies are performed as a palliative procedure in patients presenting a low survival rate not allowing to develop a Sump Syndrome and a consequent choledocholithiasis, which are long-term complications.
原发性胆总管结石是胆道手术一种相当罕见的后遗症。原发性结石起源于胆总管，质地柔软、表面光滑，呈淡黄色或棕红色，与结石形成部位的胆管形状一致。作者回顾了佩鲁贾大学外科与外科急诊系普通外科和血管外科所观察到的病例。1988年1月至1993年12月，共进行了577例开腹胆道手术，其中8例需要再次手术。在这8例患者中，有2例原发性胆总管结石特别值得关注，这2例患者之前分别进行了胆肠吻合术，即一侧对侧的Roux-en-Y吻合术或Braun袢式胆总管空肠吻合术。因此，当胆肠吻合术是在胆道根治性再次手术指征下进行时，会发生胆总管空肠吻合术后的原发性结石形成。相反，大多数胆总管空肠吻合术是作为一种姑息性手术，用于治疗那些生存率较低、不会发生长期并发症“贮袋综合征”及随之而来的胆总管结石的患者。
