Is ERCP manometry useful in the choice of treatment of stones of the common bile duct?

Summary To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took longer than 45 min; abnormal liver function tests. Moreover, 8 healthy volunteers served as controls. Our results show that the incidence of SO motor anomalies is very low in the presence of choledocholithiasis, while it is substantial in patients with suspected SO dysfunction. These observations would suggest that, unlike the traditional view, BPS is rarely secondary to biliary lithiasis. Therefore, most of the sphincterotomies performed that are based on the assumption of underlying SO pathology should be considered unnecessary. Under these circumstances, the physiological role of a functioning SO has induced us to advocate sphincterotomy, surgical or endoscopic, in selected cases only.     

利胆消石颗粒联合ERBD术治疗胆总管结石疗效评价

目的:观察利胆消石颗粒联合胆道塑料支架置入术(ERBD)治疗胆总管巨大结石的临床疗效。方法:选取52例胆总管巨大结石的梗阻性黄疸患者,随机分为对照组25例和治疗组27例,对照组仅行ERBD术,治疗组行ERBD术后加用利胆消石颗粒口服,比较两组术后胆红素消退情况,以及3个月后再次行ERCP取石的成功率。结果:治疗3 d后,两组TBIL比较无显著统计学意义(P0.05);治疗后1周,两组TBIL比较有统计学意义(P0.05)。3个月后再次行ERCP取石成功率治疗组优于对照组,差异均有统计学意义(P0.05)。结论:利胆消石颗粒联合ERBD术可有效解除胆总管巨大取石引起的梗阻性黄疸,并可提高二次取石的成功率,疗效确切。     

十二指肠镜联合腹腔镜应用于胆结石合并胆总管结石的临床价值分析

目的：探究十二指肠镜联合腹腔镜应用于胆结石合并胆总管结石的临床价值。方法：回顾性分析2011年8月-2012年8月期间本院收治的108例胆结石合并胆总管结石患者,按照随机数字表法将其分为观察组和对照组各54例。对照组采用传统开腹胆囊切除胆总管切开取石加胆道探查T管引流,观察组患者行十二指肠镜联合腹腔镜治疗,比较两组临床疗效及患者治疗期间观察指标和并发症。结果：观察组成功取石51例（94.44%）;3例（5.56%）中转开腹治疗,对照组全部手术成功,两组比较差异无统计学意义（P〉0.05）。观察组患者各项观察指标明显优于对照组,两组比较差异均有统计学意义（P〈0.05）。且两组无严重并发症发生。结论：十二指肠镜联合腹腔镜治疗胆结石合并胆总管结石的取石效果确切,且并发症少,恢复快,值得临床应用和推广。     

2D-MRCP、3D-MRCP结合冠状位B-TFE序列对胆总管结石诊断价值的比较

目的：探讨2D-MRCP、3D-MRCP结合冠状位B-TFE对胆总管结石的诊断价值。方法：回顾性分析96例经临床、手术病理证实为胆总管结石患者的术前MRI检查资料,比较分析2D-MRCP、3D-MRCP结合冠状位B-TFE对胆总管结石的诊断准确率。结果：96例患者中经手术证实2D-MRCP、3D-MRCP分别结合冠状位B-TFE序列、B-TFE序列对胆总管结石的诊断符合率分别为96.9%、92.7%和82.3%,且三者比较差异有统计学意义（X2=12.75,P＆lt;0.05）。结论：2D-MRCP、3D-MRCP分别结合冠状位B-TFE序列对胆总管结石具有很高的诊断价值,对临床治疗方案的选择具有重要指导意义。     

内外源性β-葡萄糖醛酸酶与原发性胆总管结石的关系

目的 探讨内外源性β-葡萄糖醛酸酶(β-G)与原发性胆总管结石的关系.方法 应用改良Fishman法检测35例原发性胆总管结石患者(试验组)和11例胆囊息肉患者(对照组)胆总管内胆汁中内外源性β-G活性.结果 试验组和对照组手术当天胆汁中内源性β-G活性分别为(7859.1±738.5)、(2174.9±348.4)U/L(P＜0.01);外源性β-G活性分别为(6786.1±544.3)、(1504.7±655.7)U/L(P＜0.01);试验组中13例急性患者手术当天与术后第7天胆汁中外源性β-G活性分别为(8935.7±845.9)、(2176.1±956.7)U/L(P＜0.05);22例慢性患者分别为(5137.2±540.7)、(1838.8±733.3)U/L(P＜0.05);急性患者手术当天胆汁中外源性β-G活性明显高于慢性患者(P＜0.05).结论 内、外源性β-G参与原发性胆总管结石的形成.

Abstract：

Objective To explore the role of endogenous and exogenous β-glucuronidase( β-G) in the development of primary common duct stones.Method Using modified Fishman method to test the activities of the endogenous and exogenous β -G in 35 patients with primary common duct stones(experimental group) and 11 patients with cystic polypus (control group) respectively.Results The activities of endogenous β -G in the bile of experimental group and control group were (7859.1 ± 738.5 ),(2174.9 ± 348.4 ) U/L(P ＜0.01).While the activities of exogenous β-G in experimental group and control group were (6786.1 ±544.3),(1504.7 ±655.7) U/L (P ＜0.01).In experimental group,there were significant statistical differences in the activities of the exogenous β -G in the sample obtained on the day of operation and 7 days after operation from 13 cases with the acute inflammation [(8935.7 ± 845.9),(2176.1 ± 956.7) U/L]and from 22 cases with the chronic inflammation [(5137.2 ±540.7),(1838.8 ±733.3) U/L],and there were significant higher in the activities of the exogenous β -G in the sample obtained on the day of operation from the acute inflammation compared to those from the chronic inflammation (P ＜ 0.05 ).Conclusions There is obvious correlation between either endogenous or exogenous β -G with primary common duct stones.And the endogenous β -G might be one of the fundamental cause in the development of primary common duct stones. c inflammation (P ＜     

腹腔镜胆总管探查术后胆道内置管引流胆总管一期缝合的临床应用

目的探讨腹腔镜胆总管切开探查胆道内置引流管、胆总管一期缝合的临床应用可行性、安全性和有效性。方法选用16F普通硅胶管制作胆道内置引流管,对过去5年开展腹腔镜胆总管切开取石术后胆道内置管引流胆总管一期缝合病例资料进行回顾性分析,并与同期放置T管引流的临床资料进行对照。结果自2001年9月至2006年2月共156例术中明确无残余结石、无肝内胆管结石及胆道狭窄患者行腹腔镜胆道探查术,其中107例患者放置胆道内置管引流,胆总管一期缝合,其余49例仍按传统方法放置T管引流。2组平均手术时间分别为115·2±26·7min、127·5±24·2min(P<0·05),术后住院4·8±0·92d、8·4±1·48d(P<0·05),术后平均输液量7278·5±1381、11270·2±2026ml(P>0·05),平均住院费用8932·7±1553·6元、10242·9±1594·5元(P<0·05),恢复日常工作时间14·44±1·89d、31·93±3·52d(P>0·05)。2组术后肝功能的恢复、并发症发生率无明显差异(P>0·05)。2组病人随访1~51月,平均28月,均未发现胆总管残余结石及其它胆道相关并发症。结论腹腔镜胆总管切开探查后放置胆道内置管引流胆总管一期缝合是一种安全、有效、可行的胆道引流方法。     

ERCP/EST联合LC治疗胆总管结石合并胆囊结石的临床疗效

目的 探讨内镜逆行胰胆管造影术（endoscopic retrograde pancreatic angiography,ERCP）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗胆总管结石合并胆囊结石的临床疗效。方法 选择笔者医院自2011年10月～2015年5月共收治112例胆总管结石合并胆囊结石的患者,其中73例行ERCP/EST+LC（观察组）,39例行外科开腹手术治疗（对照组）。比较两组手术的成功率、手术一般情况、术后并发症发生率、术后结石残留率及复发率等指标。结果 观察组与对照组手术成功率比较,差异无统计学意义（94.5% vs 97.4%,P >0.05）。观察组患者肛门排气时间、住院时间、禁食天数均显著小于对照组（2.32±1.04天vs 3.25±1.21天,11.05±3.10天vs 18.15±6.84天,2.17±0.52天vs 3.56±0.59天）,差异有统计学意义（P<0.05）;观察组并发症发生率显著低于对照组（7.50% vs 27.50%）,差异有统计学意义（P<0.05）;观察组患者结石残留率及复发率均显著低于对照组（1.37% vs 5.13%,9.59% vs 15.38%）,差异有统计学意义（P<0.05）。结论 ERCP/EST联合LC治疗胆总管结石合并胆囊结石具有良好的疗效,与传统开腹手术相比,具有创伤小、恢复快、术后并发症少、复发率低的优势。     

MRI及MRCP诊断胆总管结石的临床应用价值

目的 探讨磁共振成像(MRI)和磁共振胰胆管成像(MRCP)在胆石症病人中的临床应用价值。方法 回顾分析20例经MRI及MRCP检查并经手术病理结果和临床最后诊断证实的胆总管结石。结果 4例未见胆总管结石，16例显示胆总管结石，MRCP结合MRI诊断正确率达100％。结论 MRI及MRCP图像质量高，不需造影剂，无相关并发症，故对胆石症病人的诊断安全可靠。MTCP结合MRI可有效提高对胆总管结石判断的准确性。     

内镜治疗胆总管结石术后复发的危险因素分析

目的分析内镜治疗胆总管结石术后复发的危险因素。方法回顾分析187例行经内镜乳头括约肌切开术（EST）治疗胆总管结石患者的临床资料。结果6例（3．21％）出现近期并发症,28例（14．97％）出现远期并发症,其中胆总管结石复发26例（13．90％）;体重指数高、胆管炎史、胆总管直径增大及血清胆固醇含量升高是结石复发的危险因素（P〈0．05）;乳头切口小（约1．0cm）是结石复发的保护因素（P〈0．05）。结论体重指数、胆管炎史、胆总管直径、乳头切口大小及血清胆固醇含量与EST术后结石复发相关。     

腹腔镜联合纤维支气管镜治疗胆总管结石26例体会

目的探讨腹腔镜联合纤维支气管镜、开腹胆道取石器械治疗胆总管结石的可行性。方法回顾性分析我院近5年腹腔镜联合纤维支气管镜、开腹取石器械治疗胆总管结石的26例临床资料。结果手术均获得成功,无中转开腹,无胆总管结石残留。结论在无胆道镜的基础医院,腹腔镜联合纤支镜治疗胆总管结石是实用安全可行的。