Raraty M G, Pope I M, Finch M, Neoptolemos J P
Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, UK.
Baillieres Clin Gastroenterol. 1997 Dec;11(4):663-80. doi: 10.1016/s0950-3528(97)90015-4.
Gallstones are commonly found within the main bile duct (MBD) of patients undergoing cholecystectomy. Retained MBD stones are a common cause of obstructive symptoms and complications. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES) is the recommended modality for both the detection of such stones and their extraction. Recent trials of ERCP in conjunction with laparoscopic cholecystectomy suggest that it should be reserved for use post-operatively. Gallstones within the MBD are the most common single cause of acute pancreatitis. Initial treatment is supportive, although new agents designed to suppress the systemic inflammatory response are under development and have proved beneficial in clinical trials. Severe cases should be treated with systemic antibiotics and early removal of the obstructing stones by ERCP and ES. Prophylactic cholecystectomy is recommended to prevent further attacks of gallstone pancreatitis.
胆囊结石常见于接受胆囊切除术患者的主胆管（MBD）内。残留的主胆管结石是梗阻性症状和并发症的常见原因。内镜逆行胰胆管造影术（ERCP）和括约肌切开术（ES）是检测此类结石及其取出的推荐方法。近期关于ERCP联合腹腔镜胆囊切除术的试验表明，ERCP应留作术后使用。主胆管内的胆囊结石是急性胰腺炎最常见的单一病因。初始治疗是支持性的，尽管旨在抑制全身炎症反应的新型药物正在研发中，且已在临床试验中证明有益。严重病例应使用全身性抗生素治疗，并通过ERCP和ES尽早取出梗阻性结石。建议进行预防性胆囊切除术以预防胆石性胰腺炎的进一步发作。
