[1]刘润皇,廖传佳,冯明杰,等.60岁以上患者完成内镜下十二指肠括约肌切开取石后行腹腔镜胆囊切除术或保留胆囊的前瞻性随机对照研究[J].中国微创外科杂志,2007,07(2):95-99.
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60岁以上患者完成内镜下十二指肠括约肌切开取石后行腹腔镜胆囊切除术或保留胆囊的前瞻性随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年2期
页码:
95-99
栏目:
出版日期:
2007-02-20

文章信息/Info

作者:
刘润皇; 廖传佳; 冯明杰; 孙冰儿; 俞丽媚①; 赖宝山; 林旭开; 吴国伟; 刘允艺; 钟尚志; 沈祖尧②; 王田田③翻译
中国香港中文大学威尔斯亲王医院外科学系
关键词:
内镜下十二指肠括约肌切开; 腹腔镜胆囊切除术; 胆囊结石
分类号:
R657.4
文献标志码:
A
摘要:
背景内镜下十二指肠括约肌切开（endoscopic sphincterotomy，EST）取石术已是广泛接受的处理胆管结石的方法，但在伴有胆囊结石的老龄患者，是否还需要行胆囊切除尚无定论。方法EST取石术后，将178例年龄>60岁的胆道结石随机分为2组：择期胆囊切除组（89例）和保留胆囊组（89例），研究的一级终点（primary endpoint）是胆管结石或胆囊病症复发。结果择期胆囊切除组中，有6例发生胆道病症(胆管炎5例、上腹痛1例)；保留胆囊组中，21例再次发生胆道病症，包括胆管结石复发并发胆管炎13例、上腹痛2例、黄疸1例和急性胆囊炎5例（log rank 检验，P=0.001）。在5年随访中，择期胆囊切除组和胆囊保留组发生胆道病症的累积概率分别为5.8%(95%CI，2.4%~13.3%)和25.4%(95%CI，17.3%~365%)。82例行择期腹腔镜胆囊切除术中，中转开腹手术16例（19.5%）。保留胆囊组患者的死亡人数高于择期胆囊切除组（分别为19例和11例，P=0.123)。结论在EST胆管取石后，胆囊切除术可以降低胆道病症的发生，应该被推荐采纳。

参考文献/References:

[1]Cotton PB,Geenen JE,Sherman S,et al.Endoscopic sphincterotomy for stones by experts is safe,even in younger patients with normal ducts.Ann Surg,1998,227:201-204.
[2]Escourrou J,Cordova JA,Lazorthes F,et al.Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gallbladder ‘in situ’.Gut,1984,27:598-602.
[3]Ingoldby CJH,El-Saadi J,Hall RI,et al.Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gallbladders in situ.Gut,1989,30:1129-1131.
[4]Hansell DT,Millar MA,Murray WR,et al.Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders.Br J Surg,1989,76:856-858.
[5]Kullman E,Borch K,Dahlin LG,et al.Longterm followup of patients with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis.Eur J Surg，1991，157:131-135.
[6]Hill J,Martin DF,Tweedle DEF.Risks of leaving the gallbladder in situ after endoscopic sphincterotomy for bile duct stones.Br J Surg,1992,78:554-557.
[7]Prat F,Malak NA,Pelletier G,et al.Biliary Symptoms and Complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis.Gastroenterology,1996,110:894-899.
[8]PereiraLima JC,Jakobs R,Winter UH,et al.Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis.Multivariate analysis of prognostic factors for the recurrence of biliary symptoms.Gastrointest Endosc,1998,48:457-464.
[9]Cox DR,Snell EJ. Analysis of binary data.2nd Ed. Chapman & Hall,1989.
[10]Boerma D,Rauws EA,Keulemans Y,et al.Waitandsee policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bileduct stones: a randomized trial.Lancet,2002,360:761-765.
[11]Hammarstrom LE,Holmin T,Stridbeck H,et al.Longterm followup of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ.Br J Surg,1995,82:1516-1521.
[12]Targarona EM,Perez Ayuso RM,Bordas JM,et al.Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bileduct calculi in highrisk patients.Lancet,1996,347:926-929.
[13]Cuschieri A,Lezoche E,Morino M,et al.EAES multicenter prospective randomized trial comparing twostage versus singlestage management of patients with gallstone disease and ductal calculi.Surg Endosc,1999,13:952-957.
[14]Lai ECS,Mok FPT,Tan ESY,et al.Endoscopic biliary drainage for severe acute cholangitis.N Engl J Med,1992,326:1582-1586.
[15]Fan ST,Lai EC,Mok FP,et al.Early treatment of acute biliary pancreatitis by endoscopic papillotomy.N Engl J Med,1993,328:228-232.
[16]Worthley CS,Toouli J.Gallbladder nonfilling: an indication for cholecystectomy after endoscopic sphincterotomy.Br J Surg,1988,75:796-798.
[17]Bergman JJ,Rauws EA,Fockens P,et al.Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones.Lancet,1997,349:1124-1129.
[18]Li YF,Weisbrodt NW,Moody FG.Effect of bile diversion and sphincterotomy on gallbladder muscle contractility and gallstone formation.Am J Surg,1991,162:31-35.
[19]Sharma BC,Agarwal DK,Baijal SS,et al.Effect of endoscopic sphincterotomy on gall bladder bile lithogenicity and motility.Gut,1998,42:288-292.
[20]Lai KH,Lo GH,Lin CK,et al.Do patients with recurrent choledocholithiasis after endoscopic sphincterotomy benefit from regular followup? Gastrointest Endosc,2002,55:523-526.
[21]Costamagna G,Tringali A,Shah SK,et al.Longterm followup of patients after endoscopic sphincterotomy for choledocholithiasis,and risk factors for recurrence.Endoscopy,2002,34:273-279. 译自Gastroenterology,2006,130(1):96-103

备注/Memo

备注/Memo:
①临床研究与流行病学研究中心②内科治疗部③（上海第二军医大学东方肝胆外科医院内镜科，上海200438）
更新日期/Last Update: 2013-11-15