背景:胆总管切开取石T管引流后残余胆总管结石的最佳干预方法仍存在争议,尤其是在留置T管和窦道形成期间。这项研究的目的是评估两种治疗方式的效果,即内镜逆行胰胆管造影术(ERCP)和经T管窦道(CDS)的胆总管切开取石T管引流后残余胆总管结石。
方法:共112例胆总管切开术后残留胆总管结石患者纳入研究,其中50例接受了ERCP,62例通过T管窦道进行了胆道镜检查。主要结局指标包括胆道结石的切除成功率,T管引流时间,和平均住院时间。次要目标是考虑包括胆管炎在内的不良事件的发生率,胆漏,T型管迁移,胰腺炎,出血和穿孔。出院后,随访2年,记录胆总管结石复发情况.
结果:两组的取石成功率差异无统计学意义。与CDS组相比,ERCP组T管引流时间和平均住院时间明显缩短。ERCP组并发症(胆管炎、胆漏)的产生率低于CDS组,但差异无统计学意义。当T管窦道不成熟时,ERCP是清除残余胆总管结石更合适的内镜干预措施,特别是在这个时期并发胆管炎。
结论:ERCP是一种安全有效的内镜干预措施,可在不存在T管窦道限制的情况下清除胆总管切开取石T管引流术后残留的胆总管结石。
BACKGROUND: The best intervention approach for residual choledocholithiasis after choledocholithotomy T-tube drainage remains controversial, especially during the period of indwelling T tube and the formation of a sinus. The purpose of the study was to estimate the effects of two therapeutic modalities, namely endoscopic retrograde cholangiopancreatography (ERCP) and choledochfiberscope via the T-tube sinus tract (CDS) on residual choledocholithiasis after choledocholithotomy T-tube drainage.
METHODS: A total of 112 patients with residual choledocholithiasis after choledochotomy were included in the study, 50 of which underwent ERCP and 62 patients experienced choledochoscopy via the T-tube sinus tract. The primary outcome measures included the success rate of remove biliary stones, T-tube drainage time, and the average length of hospital stay. The secondary objective was to consider incidence of adverse events including cholangitis, bile leakage, T-tube migration, pancreatitis, bleeding and perforation. After hospital discharge, patients were followed up for two years and the recurrence of choledocholithiasis was recorded.
RESULTS: There was no significant difference in the success rate of stone removal between the two groups. Compared to CDS group, T-tube drainage time and the average length of hospital stay was significantly shorter in the ERCP group. The incidence of complications (cholangitis and bile leakage) in the ERCP group was lower than that in the CDS group, but there was no statistically significant difference. When the T-tube sinus tract is not maturation, ERCP was the more appropriate endoscopic intervention to remove residual choledocholithiasis, particularly complicated with cholangitis at this time period.
CONCLUSIONS: ERCP is a safe and effective endoscopic intervention to remove residual choledocholithiasis after choledocholithotomy T-tube Drainage without the condition of T-tube sinus tract restriction.