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.	張寶善. 腹腔鏡微創保膽取石的新思維新概念. 肝膽胰外科雜志, 2009, 21(5): 337-339.
2.	施維錦, 吳萍山. 膽囊功能和切除膽囊后的影響. 實用外科雜志, 1984, 4(5): 265-267.
3.	孫誠誼, 朱海濤. 膽囊功能的新認識. 世界華人消化雜志, 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.	劉永康, 何學軍, 李富建, 等. 膽囊分隔伴膽囊結石的腹腔鏡手術體會. 西南國防醫藥, 2014, 24(12): 1352-1354.
13.	劉穎, 祁志良. 分隔膽囊收縮功能的差異性研討. 中國超聲醫學雜志, 1997, 13(5): 64.
14.	梁法生, 沈慧琳, 丁潔, 等. 腹腔鏡膽囊部分切除術保膽治療膽囊畸形(附36例報告). 中國內鏡雜志, 2014, 20(1): 59-63.
15.	梁法生, 沈慧琳, 韓愛萍, 等. 腹腔鏡膽囊部分切除術保膽治療膽囊畸形. 肝膽外科雜志, 2013, 21(5): 348-351.
16.	張誠, 楊玉龍, 林美舉, 等. 膽囊肝總管側側吻合術在肝膽管結石和嵌頓性膽囊管結石中的應用. 中國內鏡雜志, 2013, 19(增刊): 134-136.
17.	張誠, 楊玉龍, 吳萍, 等. 帶側孔T管在膽囊肝總管吻合術中的應用. 中國普外基礎與臨床雜志, 2014, 21(3): 341-344.
18.	黃乘龍, 蔣怡帆, 王運兵, 等. 腹腔鏡膽囊切除術3 265例膽囊管變異的臨床總結. 局解手術學雜志, 2015, 24(1): 79-82.
19.	張小進, 田伏洲, 黃大熔, 等. 皮下通道型膽囊肝膽管成形術后膽汁成分分析. 中華實驗外科雜志, 2004, 21(8): 1003-1004.
20.	Gostishchev VK, Misnik VI, Kanorski? ID, et al. Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome.Khirurgiia (Mosk), 1991, (2): 3-6.
21.	張誠, 楊玉龍, 吳萍, 等. 壺腹周圍疾病對內鏡保膽取石手術療效的影響. 中國內鏡雜志, 2014, 20(11): 1180-1183.
22.	張誠, 楊玉龍, 林美舉, 等. 內鏡下Oddi括約肌切開治療和預防合并十二指腸乳頭憩室的膽系結石. 中華腔鏡外科雜志: 電子版, 2012, 5(6): 481-484.
23.	張誠, 楊玉龍, 張洪威, 等. 內鏡保膽取石術膽囊造瘺管拔除后膽漏16例分析. 肝膽胰外科雜志, 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. 張寶善. 腹腔鏡微創保膽取石的新思維新概念. 肝膽胰外科雜志, 2009, 21(5): 337-339.
2. 施維錦, 吳萍山. 膽囊功能和切除膽囊后的影響. 實用外科雜志, 1984, 4(5): 265-267.
3. 孫誠誼, 朱海濤. 膽囊功能的新認識. 世界華人消化雜志, 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. 劉永康, 何學軍, 李富建, 等. 膽囊分隔伴膽囊結石的腹腔鏡手術體會. 西南國防醫藥, 2014, 24(12): 1352-1354.
13. 劉穎, 祁志良. 分隔膽囊收縮功能的差異性研討. 中國超聲醫學雜志, 1997, 13(5): 64.
14. 梁法生, 沈慧琳, 丁潔, 等. 腹腔鏡膽囊部分切除術保膽治療膽囊畸形(附36例報告). 中國內鏡雜志, 2014, 20(1): 59-63.
15. 梁法生, 沈慧琳, 韓愛萍, 等. 腹腔鏡膽囊部分切除術保膽治療膽囊畸形. 肝膽外科雜志, 2013, 21(5): 348-351.
16. 張誠, 楊玉龍, 林美舉, 等. 膽囊肝總管側側吻合術在肝膽管結石和嵌頓性膽囊管結石中的應用. 中國內鏡雜志, 2013, 19(增刊): 134-136.
17. 張誠, 楊玉龍, 吳萍, 等. 帶側孔T管在膽囊肝總管吻合術中的應用. 中國普外基礎與臨床雜志, 2014, 21(3): 341-344.
18. 黃乘龍, 蔣怡帆, 王運兵, 等. 腹腔鏡膽囊切除術3 265例膽囊管變異的臨床總結. 局解手術學雜志, 2015, 24(1): 79-82.
19. 張小進, 田伏洲, 黃大熔, 等. 皮下通道型膽囊肝膽管成形術后膽汁成分分析. 中華實驗外科雜志, 2004, 21(8): 1003-1004.
20. Gostishchev VK, Misnik VI, Kanorski? ID, et al. Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome.Khirurgiia (Mosk), 1991, (2): 3-6.
21. 張誠, 楊玉龍, 吳萍, 等. 壺腹周圍疾病對內鏡保膽取石手術療效的影響. 中國內鏡雜志, 2014, 20(11): 1180-1183.
22. 張誠, 楊玉龍, 林美舉, 等. 內鏡下Oddi括約肌切開治療和預防合并十二指腸乳頭憩室的膽系結石. 中華腔鏡外科雜志: 電子版, 2012, 5(6): 481-484.
23. 張誠, 楊玉龍, 張洪威, 等. 內鏡保膽取石術膽囊造瘺管拔除后膽漏16例分析. 肝膽胰外科雜志, 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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