胆囊切除术与术后胆总管结石的关系研究

Retrospective analysis on cholecystectomy for 478 cases with primary common bile duct stones

目的探讨胆囊切除术与术后罹患原发性胆总管结石的关系。方法检索中国医科大学附属第一、第二医院普通外科1994年1月至2003年12月478例胆总管结石患者行开腹手术或经内镜十二指肠乳头括约肌切开治疗的病例资料。计算胆囊切除术后罹患原发性胆总管结石患者中的比例,并对行单纯胆囊切除术组与未行任何胆道手术组的相关分类变量和连续变量进行分析。结果胆囊切除术后原发性胆总管结石的病例共61例,占全部原发性胆总管结石病例的14.2%(61/430)。自行胆囊切除术至发现原发性胆总管结石的间隔时间平均为8.23年,最长者28年,最短者2年。多发结石或泥沙样结石多见(χ2=9.030,P<0.01),且易并发急性化脓性胆管炎(χ2=8.259,P<0.01)。结论胆囊切除有可能是原发性胆总管结石发病的一个危险因素。既往行单纯胆囊切除术的原发性胆总管结石患者发生胆系感染的可能性更大,同时提示我们感染亦可能是胆囊切除术后发生原发性胆总管结石的重要原因。

Objective To study the possible association between cholecystectomy and postoperative primary common bile duct stones. Methods We retrieved data of 478 cases treated with cholecystectomy and endoscopic duodenal papilla sphincterotomy admitted into department of general surgery of first and second hospital of China Medical University from January 1994 to December 2003 to calculate ratio of cases with primary common bile duct stones posterior to cholecystectomy to those with primary common bile duct stones. At the same time, classification variable and continuous variable were analyzed in cases with primary common bile duct stones in groups with or without cholecystectomy. Results Of all, 61 cases （14. 1%） with primary common bile duct stones had history of cholecystectomy. The interval between cholecystecto my and occurrence of primary common bile duct stones was mean 8.23 years （2-28 years）. Cases with primary common bile duct stones after treatment with cholecystectomy were more easily reliable to be accompanied by acute cholangiotitis （X^2= 8. 259, P 〈0. 01）, mostly multiple stones or sand-like stones （X^2 = 9.030, P 〈0. 01）. Conclusions Cholecystectomy may be a risk factor for primary common bile duct stones. Cases with primary common bile duct stones posterior to cholecystectomy are more easily complicated by bile infection, as indicates that infection may be responsible for primary common bile duct stones after treatment with cholecystectomy.