胆囊功能预测内镜治疗胆总管结石术后并发症的价值

Clinical value of gallbladder function in predicting postoperative complications after endoscopic treatment of calculus of common bile duct

摘要:

目的 探讨胆囊功能预测内镜治疗胆总管结石术后并发症的价值。方法 选取2018年1月－2022年12月该院行内镜清除术后胆囊完整的胆总管结石患者118例。患者肝功能恢复正常后，接受脂餐超声检查，以评估禁食容量、剩余容量和胆囊排空分数（GBEF）。分析胆总管结石患者临床特征和胆囊功能与复发性胆道并发症的关系。结果 118例胆总管结石患者中，86例合并胆囊结石，32例未合并胆囊结石。随访期间，23例患者发生胆道并发症。86例合并胆囊结石患者中，15例胆囊结石自发清除，14例因急性胆囊炎或反复绞痛接受胆囊切除术。6例因非胆道原因死亡。多数胆囊结石患者GBEF明显降低。合并胆囊结石、饮酒和内镜清理胆管疗程超过1次，是内镜治疗胆总管结石术后胆道并发症复发的危险因素。结论 合并胆囊结石的胆总管患者，GBEF较差。合并胆囊结石、饮酒和内镜清理胆管疗程超过1次，是内镜治疗胆总管结石术后胆道并发症复发的危险因素。由于胆囊结石可能自发清除，胆总管结石内镜治疗后，对胆囊进行保守监测是合适的，但有必要对复发风险高的患者进行定期随访。

Abstract:

Objective To investigate the clinical value of gallbladder function in predicting postoperative complications after endoscopic treatment of calculus of common bile duct.Methods 118 patients with complete gallbladder who underwent endoscopic clearance for calculus of common bile duct were selected from January 2018 to December 2022. After the liver function recovered to normal, the patients underwent lipid meal ultrasound examination to evaluate fasting volume, residual volume, and gallbladder ejection fraction (GBEF). The relationship between clinical features, gallbladder function and recurrent biliary complications was analyzed in patients with calculus of common bile duct.Results Among the 118 patients with calculus of common bile duct, 86 had concomitant cholecystolithiasis, while 32 did not. During the follow-up period, 23 patients developed biliary complications. Among the 86 patients with concomitant cholecystolithiasis, 15 had spontaneous clearance of cholecystolithiasis, 14 underwent cholecystectomy due to acute cholecystitis or recurrent abdominal pain, and 6 died of non-biliary causes. The GBEF of the patients with cholecystolithiasis was significantly lower. Cholecystolithiasis, alcohol consumption, and more than one endoscopic treatment were the risk factors for recurrent biliary complications after endoscopic treatment of calculus of common bile duct.Conclusion Patients with calculus of common bile duct combined with cholecystolithiasis have poor GBEF. Cholecystolithiasis, alcohol consumption, and more than one endoscopic treatment are the risk factors for recurrent biliary complications after endoscopic treatment of calculus of common bile duct. Since cholecystolithiasis may spontaneously resolve, conservative monitoring of the gallbladder after endoscopic treatment for calculus of common bile duct is appropriate, but regular follow-up is necessary for high-risk patients.