Surgical Clinic Merheim, II Department of Surgery, University of Cologne, Ostmerheimer Str. 200, 51109 Cologne, Germany.
Surg Endosc. 1998 Jun;12(6):856-64.
Common bile duct stones (CBDS) are a frequent problem (10-15%) in patients with symptomatic cholecystolithiasis. Over the last decade, new diagnostic and surgical techniques have expanded the options for their management. This report of the Consensus Development Conference is intended to summarize the current state of the art, including principal guidelines and an extensive review of the literature.
An international panel of 12 experts met under the auspices of the European Association of Endoscopic Surgery (EAES) to investigate the diagnostic and therapeutic alternatives for gallstone disease. Prior to the conference, all the experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The preconsensus document compiled out of this correspondence was altered following a discussion of the external evidence made available by the panel members and presented at the public conference session. The personal experiences of the participants and other aspects of individualized therapy were also considered.
Our panel of experts agreed that the presence of common bile duct stones should be investigated in all patients with symptomatic cholecystolithiasis. Based on preoperative noninvasive diagnostics, either endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiography should be employed for detecting CBDS. Eight of the 12 panelists recommended treating any diagnosed CBDS. For patients with no other extenuating circumstances, several treatment options exist. Stones can be extracted during ERCP, or either before or (in exceptional cases) after laparoscopic or open surgery. Bile duct clearance should always be combined with cholecystectomy. Evidence for further special aspects of CBDS treatment is equivocal and drawn from nonrandomized trials only.
The management of common bile duct stones is currently undergoing some major changes. Many diagnostic and therapeutic strategies need further study.
胆总管结石（CBDS）是有症状胆囊结石患者中常见的问题（发生率为10 - 15%）。在过去十年中，新的诊断和手术技术拓宽了其治疗选择。本共识发展会议报告旨在总结当前的技术水平，包括主要指南以及对文献的广泛综述。
一个由12名专家组成的国际小组在欧洲内镜外科学会（EAES）的支持下，探讨胆囊结石疾病的诊断和治疗选择。会议召开前，要求所有专家以已发表结果的形式提交论据。收到的所有论文根据其科学质量和相关性进行加权。根据小组成员提供的外部证据进行讨论后，对基于此次通信汇编的预共识文件进行了修改，并在公开会议上展示。还考虑了参与者的个人经验以及个体化治疗的其他方面。
我们的专家小组一致认为，所有有症状胆囊结石患者均应检查是否存在胆总管结石。基于术前非侵入性诊断，应采用内镜逆行胰胆管造影（ERCP）或术中胆管造影来检测CBDS。12名小组成员中有8人建议治疗任何诊断出的CBDS。对于没有其他特殊情况的患者，有几种治疗选择。结石可在ERCP期间取出，或在腹腔镜或开放手术之前（或在特殊情况下在术后）取出。胆管清理应始终与胆囊切除术相结合。CBDS治疗其他特殊方面的证据尚不明确，仅来自非随机试验。
胆总管结石的治疗目前正在经历一些重大变革。许多诊断和治疗策略需要进一步研究。
