Wehrmann T, Marek S, Hanisch E, Lembcke B, Caspary W F
Department of Internal Medicine II, J. W. Goethe University Hospital, Frankfurt, Germany.
Am J Gastroenterol. 1997 Jan;92(1):132-8.
To evaluate the frequency and causes of recurrent biliary colic after successful extracorporeal shock wave lithotripsy of gallstones.
Follow-up of 77 patients for 2 yr (median) after complete gallstone clearance by lithotripsy and adjuvant oral litholysis. All patients with recurrent biliary colic were examined thoroughly (laboratory data, ultrasonography, gastroscopy); the examination included gallbladder motility testing. If the patients suffered from additional gastrointestinal complaints, further symptom-guided investigations (pH-metry, lactose absorption study, enteroclysis, colonic transit time, colonoscopy) were performed. Patients without documented gallstone recurrence underwent ERCP and sphincter of Oddi manometry. Cholecystectomy was advised for patients in whom gallstones recurred, and patients with sphincter of Oddi dysfunction underwent endoscopic sphincterotomy. If other gastrointestinal disorders were diagnosed, appropriate treatment was initiated.
Twenty-seven patients (35%) experienced biliary colic during follow-up. Gallstone recurrence was documented in 17 patients, and 16 of the patients who underwent cholecystectomy became symptom-free again (follow-up: 12 months). Gallbladder hypomotility was revealed in seven of the 17 patients with gallstone recurrence compared to none of the 10 patients without gallstone recurrence (p < 0.05). Microlithiasis was not detected in bile samples from the patients whose gallstones did not recur. Sphincter of Oddi dysfunction was found in four patients, and sphincterotomy cured all of them (follow-up: 9 months). Two of the remaining six patients had functional gastrointestinal disorders (reflux, constipation) and became asymptomatic after specific treatment.
Biliary colic often recurs after successful gallstone lithotripsy. Recurrent gallbladder stones are the main cause, but another cause is sphincter of Oddi dysfunction. Neither gallbladder hypomotility nor microlithiasis seems to cause biliary symptoms in patients without recurrence of gallstones.
评估体外冲击波碎石术成功清除胆结石后复发性胆绞痛的发生率及原因。
对77例患者在通过碎石术及辅助口服溶石完全清除胆结石后进行了2年（中位数）的随访。对所有复发性胆绞痛患者进行了全面检查（实验室数据、超声检查、胃镜检查）；检查包括胆囊动力测试。如果患者有其他胃肠道不适症状，则进行进一步的症状导向性检查（pH值测定、乳糖吸收研究、小肠灌肠造影、结肠传输时间、结肠镜检查）。未记录到胆结石复发的患者接受了内镜逆行胰胆管造影（ERCP）和Oddi括约肌测压。建议复发性胆结石患者行胆囊切除术，Oddi括约肌功能障碍患者行内镜括约肌切开术。如果诊断出其他胃肠道疾病，则开始适当治疗。
27例患者（35%）在随访期间出现胆绞痛。17例患者记录到胆结石复发，16例行胆囊切除术的患者症状再次消失（随访：12个月）。复发胆结石的17例患者中有7例显示胆囊运动功能减退，而未复发胆结石的10例患者中无一例出现此情况（p<0.05）。胆结石未复发患者的胆汁样本中未检测到微结石。4例患者发现Oddi括约肌功能障碍，括约肌切开术治愈了所有患者（随访：9个月）。其余6例患者中有2例患有功能性胃肠道疾病（反流、便秘），经特异性治疗后无症状。
胆结石碎石术成功后胆绞痛常复发。复发性胆结石是主要原因，但另一个原因是Oddi括约肌功能障碍。对于未复发胆结石的患者，胆囊运动功能减退和微结石似乎均不会引起胆道症状。
