Sharma B C, Agarwal D K, Baijal S S, Saraswat V A
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
HPB Surg. 1998;11(1):23-6. doi: 10.1155/1998/63823.
After endoscopic sphincterotopy (ES) gallbladder motility increases leading to expulsion of crystals and stones. But this is not a universal phenomenon. We evaluated cholangiographic findings in patients emptying their gallbladder after ES for common bile duct (CBD) stones. Cholangiographic features of twenty patients expelling gallbladder calculi after ES were studied. Controls included 20 age and sex matched patients with gallstones and CBD stones, who did not expel gallstones after ES. Of 20 cases in study group, 9 recovered more than 20 stones each in the stool within 7 days of ES. Repeat ERCP showed empty gallbladder in all, whereas CBD was full of stones in 11 of the 20 cases. In the study group, low insertion of the cystic duct was more common (10 vs 0, p < 0.04), the cystic duct made a narrow angle (20 +/- 5 degrees vs 50 +/- 10 degrees, p < 0.04) with CBD before insertion and cystic duct diameter was higher (5 mm vs 2.5 mm, p < 0.04) as compared to controls. We conclude that in patients undergoing ES with intact gallbladder and small gallbladder calculi, spontaneous emptying of gallbladder calculi occurs, if cystic duct is wider, has low insertion and makes narrow angle with CBD before insertion.
内镜括约肌切开术后（ES），胆囊动力增加，导致晶体和结石排出。但这并非普遍现象。我们评估了因胆总管（CBD）结石接受ES治疗后胆囊排空的患者的胆管造影结果。研究了20例ES后排出胆囊结石患者的胆管造影特征。对照组包括20例年龄和性别匹配的有胆结石和CBD结石的患者，他们在ES后未排出胆结石。研究组的20例患者中，9例在ES后7天内粪便中各排出20多颗结石。重复内镜逆行胰胆管造影（ERCP）显示所有患者胆囊均已排空，而20例中有11例CBD充满结石。研究组中，胆囊管低位插入更为常见（10例 vs 0例，p < 0.04），胆囊管插入前与CBD形成的夹角较小（20±5度 vs 50±10度，p < 0.04），且胆囊管直径更大（5毫米 vs 2.5毫米，p < 0.04）。我们得出结论，对于胆囊完整且有小胆囊结石的ES患者，如果胆囊管较宽、低位插入且插入前与CBD形成的夹角较小，则胆囊结石会自发排空。
