TREATMENT OF CHOICE FOR CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE OBSTRUCTIVE SUPPURATIVE CHOLANGITIS AND LIVER-CIRRHOSIS
TREATMENT OF CHOICE FOR CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE OBSTRUCTIVE SUPPURATIVE CHOLANGITIS AND LIVER-CIRRHOSIS
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DOI：
10.1016/s0002-9610(99)80303-1
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发表时间：
1995-10-01
影响因子：
3
通讯作者：
TANAKA, M
中科院分区：
文献类型：
--
作者：
CHIJIIWA, K;KOZAKI, N;TANAKA, M
目的：探讨急性梗阻性化脓性胆管炎（AOSC）或肝硬化患者与非急性梗阻性化脓性胆管炎（AOSC）或肝硬化患者胆总管结石的治疗选择，比较手术治疗和内镜下括约肌切开术（EST）的治疗结果。患者和方法：连续362例胆总管结石患者分为三组：27例AOSC（1组），12例肝硬化（2组），323例无AOSC和肝硬化（3组）。结果：1组17例（63%）患者接受紧急治疗，其中3例死亡。2例经紧急手术治疗，均死亡；急诊EST治疗15例中仅有1例（7%）死亡。对于所有AOSC患者，手术组的发病率和死亡率分别为67%和33%，EST组的发病率和死亡率分别为24%和5%。在第2组中，2例Child C肝硬化患者在择期EST后死亡，第3组1例患者死亡。组1（11%）和组2（17%）的死亡率明显高于组3(0.3%)，虽然两种治疗方法的比较没有统计学意义，但组1（24%对67%）和组2（22%对67%）的EST的发病率均低于手术。EST所需的住院时间是手术的一半。结论：EST是胆总管结石合并AOSC或肝硬化患者的推荐治疗方法。
OBJECTIVE: To identify the treatment of choice for choledocholithiasis in patients with versus without acute obstructive suppurative cholangitis (AOSC) or liver cirrhosis, the outcomes of surgical treatment and endoscopic sphincterotomy (EST) were compared.PATIENTS AND METHODS: Three hundred sixty-two consecutive patients with choledocholithiasis were divided into three groups: 27 with AOSC (Group 1), 12 with cirrhosis (Group 2), and 323 with neither AOSC nor cirrhosis (Group 3).RESULTS: Seventeen patients (63%) in Group 1 underwent emergent treatment, and 3 of them died. Two were treated by emergent surgery and both died; only 1 (7%) of 15 treated by emergent EST died. For all patients with AOSC, morbidity and mortality rates were 67% and 33% with surgery, and 24% and 5% with EST. In Group 2, 2 patients with Child C cirrhosis died after elective EST. One patient in Group 3 died. Mortality rates were significantly higher in Group 1 (11%) and Group 2 (17%) than in Group 3 (0.3%), Although comparisons between the two treatment approaches did not achieve statistical significance, EST had lower morbidity rates than surgery in both Group 1 (24% versus 67%) and Group 2 (22% versus 67%). The required hospital stay was half as long with EST as with surgery.CONCLUSIONS: EST is the recommended treatment for patients with choledocholithiasis associated with AOSC or liver cirrhosis.