复发性胆总管结石治疗选择  

Treatment options for recurrent common bile duct stones

作　　者：赵海鹰[1] ZHAO Hai-ying(Department of General Surgery,the Fourth Affiliated Hospital of China Medical University,Shenyang 110032,China)

机构地区：[1]中国医科大学附属第四医院普通外科,辽宁沈阳110032

出　　处：《中国实用外科杂志》2024年第3期277-281,共5页Chinese Journal of Practical Surgery

基　　金：辽宁省教育厅高校基本科研项目(面上项目)(No.LJKMZ20221210)。

摘　　要：复发性胆总管结石,临床较为常见,公认的结石复发高危因素为糖尿病、胆总管扩张、十二指肠乳头旁憩室及前次胆总管结石治疗方法等,无有效预防药物。治疗选择包括内镜治疗与外科手术治疗,内镜治疗为内镜逆行胰胆管造影(ERCP)、内镜括约肌切开术(EST)与内镜乳头球囊扩张术(EPBD),外科手术治疗包括胆肠吻合术、开放胆道探查术(OCBDE)及腹腔镜胆道探查术(LCBDE)。目前没有复发性胆总管结石针对性治疗指南及共识,多参考胆总管结石相关指南,最佳治疗方案尚无定论,胆囊切除术后的胆总管取石,国内外多首选内镜治疗。无胆肠吻合手术指征的复发性胆总管结石,内镜治疗与LCBDE均是安全有效的治疗方法,LCBDE具有不损伤Oddi括约肌功能、术后结石复发率低等优势,尤其当胆管结石较多或直径较大、铸型结石、胆管明显扩张及合并乳头旁憩室等情况时,建议首选LCBDE。Recurrent common bile duct stones are common in clinics.The risk factors for the recurrence of common bile duct stones are diabetes,choledochectasia,periampullary diverticula,and previous treatment methods for choledocholithiasis.There are no effective preventive drugs.The treatment options include endoscopic treatment and surgical treatment.Endoscopic treatment includes endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST),and endoscopic papillary balloon dilation(EPBD).Surgical treatment includes cholangioenterostomy,open common bile duct exploration(OCBDE),and laparoscopic common bile duct exploration(LCBDE).At present,there is no special treatment guideline or consensus for recurrent common bile duct stones,and the best treatment option is still uncertain.Endoscopic treatment is the first choice for common bile duct stones after cholecystectomy both domestically and internationally.For recurrent common bile duct stones without indications for choledochojejunostomy,both endoscopic treatment and LCBDE are safe and effective treatment methods.LCBDE has advantages such as not damaging the function of the Oddi sphincter and low postoperative stone recurrence rate,especially when there are multiple or large bile duct stones,cast stones,significant dilation of the bile duct,and concurrent periampullary diverticula,it is recommended to choose LCBDE as the first choice.

关 键 词：复发性胆总管结石 十二指肠乳头旁憩室 内镜逆行胰胆管造影 内镜括约肌切开术 开放胆道探查术 腹腔镜胆道探查术 

分 类 号：R6[医药卫生—外科学]