Background &Aims: In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximate...Background &Aims: In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10%of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ. Methods: We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes. Results: One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12). Conclusions: In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.展开更多
目的:总结网石蓝联合取石气囊在内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗胆总管结石的方法及疗效。方法:156例临床诊断为胆总管结石患者行内镜下逆行性胰胆管造影(endoscopic retrogradecholangiopancrea to graphy,...目的:总结网石蓝联合取石气囊在内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗胆总管结石的方法及疗效。方法:156例临床诊断为胆总管结石患者行内镜下逆行性胰胆管造影(endoscopic retrogradecholangiopancrea to graphy,ERCP)证实胆总管结石后行EST,根据结石数目及大小行网石、碎石或联合取石气囊取石治疗。结果:156例ERCP确诊胆总管结石154例,行EST并取石,成功151例,成功率98.05%。术后出现并发症出血2例,轻度胰腺炎7例。结论:EST治疗胆总管结石安全、有效,网石蓝联合气囊取石取净率高。展开更多
文摘Background &Aims: In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10%of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ. Methods: We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes. Results: One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12). Conclusions: In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.
文摘目的:总结网石蓝联合取石气囊在内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗胆总管结石的方法及疗效。方法:156例临床诊断为胆总管结石患者行内镜下逆行性胰胆管造影(endoscopic retrogradecholangiopancrea to graphy,ERCP)证实胆总管结石后行EST,根据结石数目及大小行网石、碎石或联合取石气囊取石治疗。结果:156例ERCP确诊胆总管结石154例,行EST并取石,成功151例,成功率98.05%。术后出现并发症出血2例,轻度胰腺炎7例。结论:EST治疗胆总管结石安全、有效,网石蓝联合气囊取石取净率高。
