Lai K H, Peng N J, Cheng J S, Lo G H, Wang E M, Wang N M, Huang R L, Chang C F, Lin C K, Chen S M
Division of Gastroenterology, Veterans General Hospital-Kaohsiung, Taiwan.
Scand J Gastroenterol. 1996 Jun;31(6):612-5. doi: 10.3109/00365529609009136.
Change in gallbladder function may occur in patients with an intact gallbladder after endoscopic sphincterotomy (EST). This study was designed to evaluate the factors influencing gallbladder filling after EST and the correlation between gallbladder function and stone recurrence.
Sixty Chinese patients with symptomatic choledocholithiasis and an intact gallbladder received EST to clear the bile ducts. They were further investigated with sphincter of Oddi manometry (SOM), quantitative cholescintigraphy (QC), and long-term clinical follow-up.
Fifty-six of the 60 patients in the study group were confirmed to have a loss of sphincteric function by SOM. QC showed normal gallbladder filling in 35 of these patients and delayed or non-filling in 21 patients. A significantly higher incidence of normal gallbladder filling occurred in patients with juxtapapillary diverticulum than in those without (P < 0.02), but preexisting cholecystolithiasis had no effect on it. During the follow-up period (median, 32 months: range, 9-54 months) 10 of 56 patients developed recurrent choledocholithiasis. There was no correlation between the status of gallbladder filling, preexisting cholecystolithiasis, and recurrent stones, but 9 of the 10 patients with recurrent stones had a juxtapapillary diverticulum. Repeated endoscopic treatment was satisfactory in eight patients, and only two patients received cholecystectomy.
EST does not alter gallbladder function in most patients. Juxtapapillary diverticulum may facilitate gallbladder filling after EST, but it is also a possible factor for recurrent choledocholithiasis.
内镜括约肌切开术（EST）后，胆囊功能可能在胆囊完好的患者中发生改变。本研究旨在评估影响EST后胆囊充盈的因素以及胆囊功能与结石复发之间的相关性。
60例有症状的胆总管结石且胆囊完好的中国患者接受EST以清理胆管。他们进一步接受了Oddi括约肌测压（SOM）、定量胆闪烁显像（QC）以及长期临床随访。
研究组60例患者中有56例经SOM证实存在括约肌功能丧失。QC显示其中35例患者胆囊充盈正常，21例患者胆囊充盈延迟或无充盈。伴有乳头旁憩室的患者胆囊充盈正常的发生率显著高于无乳头旁憩室的患者（P < 0.02），但既往存在的胆囊结石对此无影响。在随访期（中位时间32个月：范围9 - 54个月），56例患者中有10例发生复发性胆总管结石。胆囊充盈状态、既往存在的胆囊结石与复发性结石之间无相关性，但10例复发性结石患者中有9例伴有乳头旁憩室。8例患者重复内镜治疗效果满意，仅2例患者接受了胆囊切除术。
EST在大多数患者中不会改变胆囊功能。乳头旁憩室可能有助于EST后胆囊充盈，但它也是复发性胆总管结石的一个可能因素。
