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| 1 | Restoration of common bile duct diameter within 2 weeks after endoscopic stone retraction is a preventive factor for stone recurrence显示文摘Background: Little information is available about the relationship between restoration of common bile duct(CBD) diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBD stone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography(ERCP).Methods: From January 2006 to December 2010, 238 patients underwent the first and the second session of ERCP for the removal of CBD stones. Among them, 173 were over 65 years old. These patients were divided into recurrent group and non-recurrent group. Restoration of CBD diameter and patients' characteristics were compared.Results: There was no statistical difference in patients' characteristics, associated diseases, or ERCP-related complications between the two groups. Reduction of CBD diameter was significantly larger in the nonrecurrent group(2.7 ± 1.7 mm) compared to that in the recurrent group(1.4 ± 2.3 mm, P = 0.002). The proportion of patients with restoration of CBD diameter were significantly lower in the recurrent group(6/42, 14.3%) compared with that in the non-recurrent group(67/131, 51.1%)(P < 0.01).Conclusions: There is an inverse relationship between restoration of CBD diameter and CBD stone recurrence. Therefore, patients without restoration of CBD diameter within 2 weeks after endoscopic stone removal should be monitored more frequently. | Jin Jeon Sung Uk Lim Chang-Hwan Park Chung-Hwan Jun Seon-Young Park Jong-Sun Rew | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，3： | 25 |
| 2 | 胆总管结石治疗方法的研究进展显示文摘胆总管结石是临床常见病及多发病,主要治疗方法有内镜及手术治疗,随着内镜及腹腔镜技术的发展,其治疗趋于微创化。本文就胆总管结石的治疗方法进展作一概述。 | 李强 汪志伟 柴琛 | 2017 | 胃肠病学和肝病学杂志2017，26，12： | 12 |
| 3 | Could saline irrigation clear all residual common bile duct stones after lithotripsy?A self-controlled prospective cohort study显示文摘BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones. | Yan-Yan Lin Yu-Dong Wang Ping Yue Xian-Zhuo Zhang Joseph W Leung Pan-Pan Jiao Man Yang Hai-Ping Wang Bing Bai Ying Liu Jin-Duo Zhang Hong-Bo Chen Wen-Bo Meng Xun Li | 2021 | World Journal of Gastroenterology2021，27，4： | 4 |
| 4 | 胆道支架治疗胆总管巨大结石显示文摘目的探讨胆道支架在治疗胆总管巨大结石中的作用和价值。方法对32例胆总管巨大结石患者,在行oddi括约肌切开术内镜取石失败后做塑料胆道支架置入术治疗,术后随访6个月。结果 32例患者均顺利置入胆道支架,术后黄疸、腹痛等症状均得到缓解,术后6个月行内镜逆行胰胆管造影(ERCP),32例中3例结石消失,25例均有不同程度缩小,4例未见明显缩小;29例残余结石再次取石,其中25例成功取石,有4例仍取石困难,继续放置胆道支架引流观察。胆道支架治疗胆总管巨大结石成功率87.5%。结论胆道支架治疗胆总管巨大结石具有操作简便、操作时间短,并发症少、疗效满意、安全有效等优点。 | 迟海本 高德宝 王岩 | 2014 | 天津医药2014，42，9： | 3 |
| 5 | 胆管内超声用于胆总管结石内镜下取石显示文摘目的观察胆管内超声(IDUS)用于胆总管结石内镜下取石中的价值。方法回顾性分析148例接受内镜逆行胰胆管造影(ERCP)联合内镜下括约肌切开术(EST)的胆总管结石患者,对取石后胆总管造影显示结石完全清除者行IDUS,观察有无胆总管残石;对存在较大残石(≥3 mm)者重复行ERCP联合EST取石。术后随访,观察胆总管结石复发情况及其影响因素。结果148例经ERCP联合EST取石后,胆总管造影均确认胆总管结石完全清除。IDUS发现其中61例仍存在残石,且21例残石≥3 mm;对该21例重复取石,直至结石完全清除。术中及术后均未见严重不良反应。术后随访3~24个月,IDUS显示108例结石完全清除者与40例存在残石者结石复发率分别为8.33%(9/108)、62.50%(25/40),差异有统计学意义(P<0.01);术后24个月累积无复发率差异有统计学意义(88.40%、14.40%,P<0.01)。多因素分析结果显示,IDUS所示胆总管残石、胆总管直径及角度均为结石复发的独立危险因素(P均<0.05)。结论IDUS能发现胆总管造影难以显示的胆总管残石、尤其细小结石(<3 mm),用于辅助ERCP联合EST取石有助于减少术后结石复发。 | 蔡怀阳 叶亮 李运泽 | 2021 | 中国介入影像与治疗学2021，18，9： | 3 |
| 6 | 内镜下柱状气囊十二指肠乳头扩张治疗胆总管结石的研究进展显示文摘内镜下十二指肠乳头括约肌切开术在西方诊治指南中仍被视为治疗胆总管结石的金标准,但在亚洲,内镜下十二指肠乳头气囊扩张术已被内镜医师普遍应用,并作为治疗胆总管结石的常规方法。近年来,内镜下大气囊乳头扩张(EPLBD)与内镜下乳头小切开联合大气囊扩张(ESLBD)也越来越多的用于治疗胆总管结石。单独EPLBD与ESLBD具有同样的取石效果,但均是不能保留Oddi括约肌功能的方法。定期随访对早期发现和治疗再发性胆总管结石是必要的。 | 邵明山 李能平 | 2016 | 医学综述2016，22，21： | 1 |
| 7 | Failure of sequential biliary stenting for unsuccessful common bile duct stone removal显示文摘AIM: To determine the factors associated with the failure of stone removal by a biliary stenting strategy. METHODS: We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared. RESULTS: Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed beforecomplete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions). CONCLUSION: The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal. | Varayu Prachayakul Pitulak AswakulV | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，6： | 0 |
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