Clinical Analysis for Reason and Treatment Strategy of Gallbladder Muddy Stones after Cholecystolithotomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGCheng ,  YANGYu-long , LIJing-yi , MAYue-feng , SHILi-jun , ZHANGHong-wei , LINMei-ju

Department of Biliary Minimally Invasive Surgery, Zhongshan Hospital, Dalian University, Dalian 116001, Liaoning Province, China;

Corresponding author：

YANGYu-long, Email: YYL516@126.com

Keywords：

Gallbladder muddy stones; Cholecystolithotomy; Septation gallbladder; Periampullary diverticula; Pancreaticobiliary maljunction; Hepatocholangioplasty with the use of gallbladder

DOI：

10.7507/1007-9424.20160088

Video：

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Objective To discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. Methods The clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. Results There were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. Conclusion Bile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.

Citation： ZHANGCheng, YANGYu-long, LIJing-yi, MAYue-feng, SHILi-jun, ZHANGHong-wei, LINMei-ju. Clinical Analysis for Reason and Treatment Strategy of Gallbladder Muddy Stones after Cholecystolithotomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(3): 333-337. doi: 10.7507/1007-9424.20160088 Copy

1.	张宝善. 腹腔镜微创保胆取石的新思维新概念. 肝胆胰外科杂志, 2009, 21(5): 337-339.
2.	施维锦, 吴萍山. 胆囊功能和切除胆囊后的影响. 实用外科杂志, 1984, 4(5): 265-267.
3.	孙诚谊, 朱海涛. 胆囊功能的新认识. 世界华人消化杂志, 2012, 20(33): 3181-3185.
4.	Inoue K. Gallbladder sludge and stone formation vary with the pathophysiological condition. J Gastroenterol, 2001, 36(5): 356-357.
5.	Oak JH, Paik CN, Chung WC, et al. Risk factors for recurrence of symptomatic common bile duct stones after cholecystectomy. Gastroenterol Res Pract, 2012, 2012: 417821.
6.	Ko CW, Schulte SJ, Lee SP. Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol, 2005, 3(7): 672-678.
7.	Il'chenko IA, Deliukina OV. Significance of biliary dysfunction in the pathogenesis of gallstone disease. Eksp Klin Gastroenterol, 2011, (7): 70-78.
8.	Li ZH, Chen M, Liu JK, et al. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases. World J Gastroenterol, 2005, 11(17): 2678-2680.
9.	Will U, Müller AK, Fueldner F, et al. Endoscopic papillectomy: data of a prospective observational study. World J Gastroenterol, 2013, 19(27): 4316-4324.
10.	Kamisawa T, Takuma K, Itokawa F, et al. Endoscopic diagnosis of pancreaticobiliary maljunction. World J Gastrointest Endosc, 2011, 3(1): 1-5.
11.	Horiguchi S, Kamisawa T. Major duodenal papilla and its normal anatomy. Dig Surg, 2010, 27(2): 90-93.
12.	刘永康, 何学军, 李富建, 等. 胆囊分隔伴胆囊结石的腹腔镜手术体会. 西南国防医药, 2014, 24(12): 1352-1354.
13.	刘颖, 祁志良. 分隔胆囊收缩功能的差异性研讨. 中国超声医学杂志, 1997, 13(5): 64.
14.	梁法生, 沈慧琳, 丁洁, 等. 腹腔镜胆囊部分切除术保胆治疗胆囊畸形(附36例报告). 中国内镜杂志, 2014, 20(1): 59-63.
15.	梁法生, 沈慧琳, 韩爱萍, 等. 腹腔镜胆囊部分切除术保胆治疗胆囊畸形. 肝胆外科杂志, 2013, 21(5): 348-351.
16.	张诚, 杨玉龙, 林美举, 等. 胆囊肝总管侧侧吻合术在肝胆管结石和嵌顿性胆囊管结石中的应用. 中国内镜杂志, 2013, 19(增刊): 134-136.
17.	张诚, 杨玉龙, 吴萍, 等. 带侧孔T管在胆囊肝总管吻合术中的应用. 中国普外基础与临床杂志, 2014, 21(3): 341-344.
18.	黄乘龙, 蒋怡帆, 王运兵, 等. 腹腔镜胆囊切除术3 265例胆囊管变异的临床总结. 局解手术学杂志, 2015, 24(1): 79-82.
19.	张小进, 田伏洲, 黄大熔, 等. 皮下通道型胆囊肝胆管成形术后胆汁成分分析. 中华实验外科杂志, 2004, 21(8): 1003-1004.
20.	Gostishchev VK, Misnik VI, Kanorskiĭ ID, et al. Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome.Khirurgiia (Mosk), 1991, (2): 3-6.
21.	张诚, 杨玉龙, 吴萍, 等. 壶腹周围疾病对内镜保胆取石手术疗效的影响. 中国内镜杂志, 2014, 20(11): 1180-1183.
22.	张诚, 杨玉龙, 林美举, 等. 内镜下Oddi括约肌切开治疗和预防合并十二指肠乳头憩室的胆系结石. 中华腔镜外科杂志: 电子版, 2012, 5(6): 481-484.
23.	张诚, 杨玉龙, 张洪威, 等. 内镜保胆取石术胆囊造瘘管拔除后胆漏16例分析. 肝胆胰外科杂志, 2014, 26(2): 145-147.
24.	Hutton SW, Sievert CE Jr, Vennes JA, et al. Spontaneous passage of glass beads from the canine gallbladder: facilitation by sphinctero-tomy. Gastroenterology, 1988, 94(4): 1031-1035.
25.	Dhiman RK, Phanish MK, Chawla YK, et al. Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy. J Hepatol, 1997, 26(6): 1300-1305.

1. 张宝善. 腹腔镜微创保胆取石的新思维新概念. 肝胆胰外科杂志, 2009, 21(5): 337-339.
2. 施维锦, 吴萍山. 胆囊功能和切除胆囊后的影响. 实用外科杂志, 1984, 4(5): 265-267.
3. 孙诚谊, 朱海涛. 胆囊功能的新认识. 世界华人消化杂志, 2012, 20(33): 3181-3185.
4. Inoue K. Gallbladder sludge and stone formation vary with the pathophysiological condition. J Gastroenterol, 2001, 36(5): 356-357.
5. Oak JH, Paik CN, Chung WC, et al. Risk factors for recurrence of symptomatic common bile duct stones after cholecystectomy. Gastroenterol Res Pract, 2012, 2012: 417821.
6. Ko CW, Schulte SJ, Lee SP. Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol, 2005, 3(7): 672-678.
7. Il'chenko IA, Deliukina OV. Significance of biliary dysfunction in the pathogenesis of gallstone disease. Eksp Klin Gastroenterol, 2011, (7): 70-78.
8. Li ZH, Chen M, Liu JK, et al. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases. World J Gastroenterol, 2005, 11(17): 2678-2680.
9. Will U, Müller AK, Fueldner F, et al. Endoscopic papillectomy: data of a prospective observational study. World J Gastroenterol, 2013, 19(27): 4316-4324.
10. Kamisawa T, Takuma K, Itokawa F, et al. Endoscopic diagnosis of pancreaticobiliary maljunction. World J Gastrointest Endosc, 2011, 3(1): 1-5.
11. Horiguchi S, Kamisawa T. Major duodenal papilla and its normal anatomy. Dig Surg, 2010, 27(2): 90-93.
12. 刘永康, 何学军, 李富建, 等. 胆囊分隔伴胆囊结石的腹腔镜手术体会. 西南国防医药, 2014, 24(12): 1352-1354.
13. 刘颖, 祁志良. 分隔胆囊收缩功能的差异性研讨. 中国超声医学杂志, 1997, 13(5): 64.
14. 梁法生, 沈慧琳, 丁洁, 等. 腹腔镜胆囊部分切除术保胆治疗胆囊畸形(附36例报告). 中国内镜杂志, 2014, 20(1): 59-63.
15. 梁法生, 沈慧琳, 韩爱萍, 等. 腹腔镜胆囊部分切除术保胆治疗胆囊畸形. 肝胆外科杂志, 2013, 21(5): 348-351.
16. 张诚, 杨玉龙, 林美举, 等. 胆囊肝总管侧侧吻合术在肝胆管结石和嵌顿性胆囊管结石中的应用. 中国内镜杂志, 2013, 19(增刊): 134-136.
17. 张诚, 杨玉龙, 吴萍, 等. 带侧孔T管在胆囊肝总管吻合术中的应用. 中国普外基础与临床杂志, 2014, 21(3): 341-344.
18. 黄乘龙, 蒋怡帆, 王运兵, 等. 腹腔镜胆囊切除术3 265例胆囊管变异的临床总结. 局解手术学杂志, 2015, 24(1): 79-82.
19. 张小进, 田伏洲, 黄大熔, 等. 皮下通道型胆囊肝胆管成形术后胆汁成分分析. 中华实验外科杂志, 2004, 21(8): 1003-1004.
20. Gostishchev VK, Misnik VI, Kanorskiĭ ID, et al. Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome.Khirurgiia (Mosk), 1991, (2): 3-6.
21. 张诚, 杨玉龙, 吴萍, 等. 壶腹周围疾病对内镜保胆取石手术疗效的影响. 中国内镜杂志, 2014, 20(11): 1180-1183.
22. 张诚, 杨玉龙, 林美举, 等. 内镜下Oddi括约肌切开治疗和预防合并十二指肠乳头憩室的胆系结石. 中华腔镜外科杂志: 电子版, 2012, 5(6): 481-484.
23. 张诚, 杨玉龙, 张洪威, 等. 内镜保胆取石术胆囊造瘘管拔除后胆漏16例分析. 肝胆胰外科杂志, 2014, 26(2): 145-147.
24. Hutton SW, Sievert CE Jr, Vennes JA, et al. Spontaneous passage of glass beads from the canine gallbladder: facilitation by sphinctero-tomy. Gastroenterology, 1988, 94(4): 1031-1035.
25. Dhiman RK, Phanish MK, Chawla YK, et al. Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy. J Hepatol, 1997, 26(6): 1300-1305.

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Clinical Analysis for Reason and Treatment Strategy of Gallbladder Muddy Stones after Cholecystolithotomy

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