Processing Strategy and Etiological Analysis of Relapsed Biliary Calculi after Endoscopic Sphincterotomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GE Jiayun ¹ , LI Du ² ,  ZOU Hao ¹ , WANG Ling ¹ , LI Xiao ¹ , HUANG Songquan ¹

1.The Second Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical College, Kunming 650101, China;;
2.Department of Surgery, Fuming People’s Hospital of Kunming City, Yunnan Province, Fuming 650400, China;

Corresponding author：

ZOU Hao, Email: newzouhao@hotmail.com

Keywords：

Biliary calculi; Endoscopic sphincterotomy; Replase; Operation; Choledochojejunostomy with Roux-en-y anastomosis

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Objective To investigate the best management in treating relapsed biliary calculi after endoscopic sphincterotomy (EST).
Methods The clinical data of 96 patients with relapsed biliary calculi after EST in our hospital from February 1999 to February 2009 were retrospectively analysed. The patients were grouped into two groups by the size of calculi under magnetic resonance cholangiopancreatography: surgical group (the size of calculi was bigger than 1.0 cm) in 79 cases and non-surgical group (the size of stone was smaller than 1.0 cm and the patients were performed EST again) in 17 cases. The relapsed biliary calculi rate between two groups were compared.
Results In the surgical group, the 79 patients (82.29%) were performed common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis. In the non-surgical group, the 17 patients (17.17%) were performed EST again. The relapsed biliary calculi rate was 2.63% in the surgical group, 70.59% in the non-surgical group. There was marked difference in the relapsed biliary calculi rate between surgical group and non-surgical group (P lt;0.05).
Conclusion The operation treatment is the best way for relapsed biliary calculi after EST, and has good curative effect. The best manner of operation treatment is common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis.

Citation： GE Jiayun ,LI Du,ZOU Hao,WANG Ling,LI Xiao,HUANG Songquan. Processing Strategy and Etiological Analysis of Relapsed Biliary Calculi after Endoscopic Sphincterotomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(1): 77-80. doi: Copy

1.	李达周, 张志坚, 王蓉, 等. ERCP联合LC治疗胆总管结石合并胆囊结石临床体会 [J]. 临床消化病杂志, 2009; 21(5): 299300.
2.	沈火剑, 季福. 腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石比较 [J]. 临床外科杂志, 2009； 17(8): 522524.
3.	Kawai K, Akasaka Y, Murakami K, et al. Endoscopic sphincterotomy of the ampulla of Vater [J]. Gastrointest Endosc, 1971; 20: 148151.
4.	Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author’s transl) [J]. Dtsch Med Wochenschr, 1974; 99: 496497.
5.	Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones [J]. Gut, 2008; 57(7): 10041021.
6.	黄志强. 在微创外科时代对肝内胆管结石外科治疗的再认识 [J]. 中国普外基础与临床杂志, 2006; 13(4): 371372.
7.	司丽娟, 任建林, 迟宝荣. 肝内外胆管结石的内镜治疗 [J]. 世界华人消化杂志, 2007; 15(30): 32333236.
8.	LI ZH, CHEN M, LIU JK, et al. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases [J]. World J Gastroenterol, 2005; 11(17): 26782680.
9.	樊超, 于良, 孙昊. 内镜下十二指肠乳头括约肌切开术的远期疗效观察及其并发症的相关危险因素分析 [J]. 西安交通大学学报, 2009; 30 (1): 103106.
10.	Mandryka Y, Klimczak J, Duszewski M, et al. Bile duct infections as a late complication after endoscopic sphincterotomy [J]. Pol Merkur Lekarski, 2006； 21(126): 525527.
11.	Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: longterm (more than 10 years) followup study [J]. Am J Gastroenterol, 2002； 97(11): 27632767.
12.	叶丽萍，林敏华，何赛琴，等. 中小切口的乳头括约肌切开术加鼻胆管引流在治疗胆总管结石中的价值 [J]. 中华消化内镜杂志, 2003； 20(5): 336337.
13.	Healy K, Chamsuddin A, Spivey J, et al. Pertaneous endoscopic holmium laser lithotripsy for management of complicated biliary calculi [J]. JSLS， 2009； 13(2): 184189.
14.	王炳煌, 朱红, 李立春. Oddi括约肌松弛与复发性胆管炎胆结石 [J]. 肝胆外科杂志, 2002； 10(1): 1012.
15.	王炳煌, 张小文, 李立春, 等. 返流性胆管炎与胆肠吻合术 [J]. 中华肝胆外科杂志, 2003； 9(7): 393395.
16.	王同宪, 莫同珍. 32例肝胆管结石行胆肠RouxY吻合术分析 [J]. 肝胆胰外科杂志, 2009； 21(4): 319320.
17.	李海民, 窦科峰. 胆管良性疾病胆肠吻合术式的选择 [J]. 中国普外基础与临床杂志, 2002； 9(3): 191193.
18.	石刚, 吴硕东, 曾艳. 腹腔镜下胆肠吻合术二例报道 [J]. 岭南现代临床外科, 2005； 5(1): 78.
19.	秦明放, 吴瑜. 腹腔镜胆肠、胃肠吻合术在晚期胰腺癌的应用（附15例报告） [J].中国普外基础与临床杂志, 2004； 11(3): 201203.
20.	嵇武，陈训如，何振平. 腹腔镜胆肠吻合术 [J]. 中国普外基础与临床杂志， 2001； 8(2): 128130.
21.	田伏洲, 赵铁军, 胡建中, 等. 皮下通道型胆囊肝胆管成形术治疗肝胆管结石和狭窄 [J]. 中华外科杂志, 1997； 35(1): 2830.
22.	王雨, 田伏洲，蔡忠红，等. 皮下通道型胆囊肝胆管成形术治疗肝胆管结石和胆管狭窄的中远期疗效观察 [J]. 中国普外基础与临床杂志, 2003； 10(1): 5859.
23.	杨玉龙, 陈海龙, 谭文翔, 等. 胆道镜经银夹标记的胆道通道治疗胆肠吻合术后胆管结石复发 [J]. 中国普外基础与临床杂志, 2008； 15(2): 132133.
24.	石景森. 肝内胆管结石的手术方式决择 [J]. 中国普外基础与临床杂志, 2006； 13(4): 373374.
25.	程南生. 肝胆管结石并发症的防治 [J]. 中国普外基础与临床杂志, 2006； 13(4): 380381.
26.	嵇振岭, 周家华, 张炜, 等. 应用腔镜、内镜联合技术同期与分期处理胆囊结石合并肝外胆管结石的比较 [J]. 中国普外基础与临床杂志, 2009； 16(5): 400402.

1. 李达周, 张志坚, 王蓉, 等. ERCP联合LC治疗胆总管结石合并胆囊结石临床体会 [J]. 临床消化病杂志, 2009; 21(5): 299300.
2. 沈火剑, 季福. 腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石比较 [J]. 临床外科杂志, 2009； 17(8): 522524.
3. Kawai K, Akasaka Y, Murakami K, et al. Endoscopic sphincterotomy of the ampulla of Vater [J]. Gastrointest Endosc, 1971; 20: 148151.
4. Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author’s transl) [J]. Dtsch Med Wochenschr, 1974; 99: 496497.
5. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones [J]. Gut, 2008; 57(7): 10041021.
6. 黄志强. 在微创外科时代对肝内胆管结石外科治疗的再认识 [J]. 中国普外基础与临床杂志, 2006; 13(4): 371372.
7. 司丽娟, 任建林, 迟宝荣. 肝内外胆管结石的内镜治疗 [J]. 世界华人消化杂志, 2007; 15(30): 32333236.
8. LI ZH, CHEN M, LIU JK, et al. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases [J]. World J Gastroenterol, 2005; 11(17): 26782680.
9. 樊超, 于良, 孙昊. 内镜下十二指肠乳头括约肌切开术的远期疗效观察及其并发症的相关危险因素分析 [J]. 西安交通大学学报, 2009; 30 (1): 103106.
10. Mandryka Y, Klimczak J, Duszewski M, et al. Bile duct infections as a late complication after endoscopic sphincterotomy [J]. Pol Merkur Lekarski, 2006； 21(126): 525527.
11. Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: longterm (more than 10 years) followup study [J]. Am J Gastroenterol, 2002； 97(11): 27632767.
12. 叶丽萍，林敏华，何赛琴，等. 中小切口的乳头括约肌切开术加鼻胆管引流在治疗胆总管结石中的价值 [J]. 中华消化内镜杂志, 2003； 20(5): 336337.
13. Healy K, Chamsuddin A, Spivey J, et al. Pertaneous endoscopic holmium laser lithotripsy for management of complicated biliary calculi [J]. JSLS， 2009； 13(2): 184189.
14. 王炳煌, 朱红, 李立春. Oddi括约肌松弛与复发性胆管炎胆结石 [J]. 肝胆外科杂志, 2002； 10(1): 1012.
15. 王炳煌, 张小文, 李立春, 等. 返流性胆管炎与胆肠吻合术 [J]. 中华肝胆外科杂志, 2003； 9(7): 393395.
16. 王同宪, 莫同珍. 32例肝胆管结石行胆肠RouxY吻合术分析 [J]. 肝胆胰外科杂志, 2009； 21(4): 319320.
17. 李海民, 窦科峰. 胆管良性疾病胆肠吻合术式的选择 [J]. 中国普外基础与临床杂志, 2002； 9(3): 191193.
18. 石刚, 吴硕东, 曾艳. 腹腔镜下胆肠吻合术二例报道 [J]. 岭南现代临床外科, 2005； 5(1): 78.
19. 秦明放, 吴瑜. 腹腔镜胆肠、胃肠吻合术在晚期胰腺癌的应用（附15例报告） [J].中国普外基础与临床杂志, 2004； 11(3): 201203.
20. 嵇武，陈训如，何振平. 腹腔镜胆肠吻合术 [J]. 中国普外基础与临床杂志， 2001； 8(2): 128130.
21. 田伏洲, 赵铁军, 胡建中, 等. 皮下通道型胆囊肝胆管成形术治疗肝胆管结石和狭窄 [J]. 中华外科杂志, 1997； 35(1): 2830.
22. 王雨, 田伏洲，蔡忠红，等. 皮下通道型胆囊肝胆管成形术治疗肝胆管结石和胆管狭窄的中远期疗效观察 [J]. 中国普外基础与临床杂志, 2003； 10(1): 5859.
23. 杨玉龙, 陈海龙, 谭文翔, 等. 胆道镜经银夹标记的胆道通道治疗胆肠吻合术后胆管结石复发 [J]. 中国普外基础与临床杂志, 2008； 15(2): 132133.
24. 石景森. 肝内胆管结石的手术方式决择 [J]. 中国普外基础与临床杂志, 2006； 13(4): 373374.
25. 程南生. 肝胆管结石并发症的防治 [J]. 中国普外基础与临床杂志, 2006； 13(4): 380381.
26. 嵇振岭, 周家华, 张炜, 等. 应用腔镜、内镜联合技术同期与分期处理胆囊结石合并肝外胆管结石的比较 [J]. 中国普外基础与临床杂志, 2009； 16(5): 400402.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Processing Strategy and Etiological Analysis of Relapsed Biliary Calculi after Endoscopic Sphincterotomy

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