Feasibility analysis of treating small choledocholithiasis with combination of choleretic and stone-removal drugs

doi:10.3877/cma.j.issn.1674-0793.2019.03.008

Abstract

Abstract:

Objective

To explore the therapeutic effects of small choledocholithiasis treated with the combination of choleretic and calculus-removal drugs, so as to improve the effect of non-operative treatment of small choledocholithiasis.

Methods

The clinical data of forty-one patients with common bile duct calculi (diameter≤8 mm, number≤3) treated with choleretic (33% magnesium sulfate) and lithotripsy (belladonna tablets, anisodamine) in Beijing Electric Power Hospital from November 2014 to January 2018 were retrospectively analyzed.

Results

The successful rate of stone removal in 41 patients was 73.17%(30/41), of which 30 cases (including 2 cases with acute cholecystitis) were successful group, and 11 cases (including 5 cases with acute cholecystitis) were failure group. Comparison of two groups with acute cholecystitis, stone discharge, stone discharge time and hospital stay showed no significant differences in stone discharge [1-3 (1.1±0.4) vs 1-2 (1.2±0.4), t=0.086, P=0.032] and hospital stay [3-23 (12.7±5.2) dvs 10-23 (15.8±4.1) d, t=2.014, P=0.051], while the failure group had a higher proportion of acute cholecystitis (45.45% vs 6.67%, χ²=6.033, P=0.024) and the time of lithotripsy was significantly prolonged [5-14 (9.4±3.5) d vs 3-16 (6.0±3.7) d, t=2.522, P=0.016]. The liver function indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), conjugated bilirubin (DBil), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) after lithotripsy in the successful group were significantly lower than those before lithotripsy (t=3.369, 4.957, 5.112, 5.231, 2.264, 2.422; all P<0.05). After 6-18 months of follow-up, all 41 patients had normal liver function and no recurrence or regeneration of common bile duct stones.

Conclusion

The combined administration of choleretic and lithagogue drugs can promote the small choledocholithiasis into duodenum, reduce the chance of surgical treatment of small choledocholithiasis, not only as a non-operative treatment for the small choledocholithiasis, but also as a preoperative preparatory measure for the choledocholithiasis, so as to maximize the simplification of treatment, reduce patient pain, decrease treatment risks and avoid unnecessary surgery.

Key words: Choledocholithiasis, Cholagogues and choleretics, Calculus-removal, Drug therapy, Combination.

Limin Liu, Zongming Zhang, Chong Zhang, Zhuo Liu, Hongwei Yu, Mingwen Zhu. Feasibility analysis of treating small choledocholithiasis with combination of choleretic and stone-removal drugs[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(03): 202-207.

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References 20

[1]	Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center[J]. Ann Surg Treat Res, 2014, 86(1): 1-6. URL
[2]	张宗明, 苑海明, 张翀. 双镜联合同期治疗胆囊结石合并胆总管结石的策略[J]. 中华消化外科杂志, 2015, 14(4): 280-283.
[3]	Kim TH, Kim JH, Seo DW, et al. International consensus guidelines for endoscopic papillary large-balloon dilation[J]. Gastrointest Endosc, 2016, 83(1): 37-47.
[4]	Nussinson E, Shibli F, Shahbari A. The combined laparoscopic and endoscopic treatment for concomitant gallstones and common bile duct stones: two stage or single stage management?[J]. Harefuah, 2015, 154(10): 649-652, 675.
[5]	Liu JG, Wang YJ, Shu GM, et al. Laparoscopic versus endoscopic management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy: a meta-analysis[J]. Laparoendosc Adv Surg Tech A, 2014, 24(5): 287-294.
[6]	Sato Y, Okamura S, Nakasono M, et al. Evaluation of serum amylase and gabexate mesilate with endoscopic papillary balloon dilatation[J]. Med Invest, 2007, 54: 65-71.
[7]	张强, 吴硕东, 王伟. 吗啡、山莨菪碱及硫酸镁对Oddi括约肌压力的影响[J]. 解剖科学进展, 2008, 14(2): 161-164．
[8]	周良, 吴国兴. 硫酸镁治疗胆道蛔虫病36例观察[J]. 热带病与寄生虫学, 2001, 30(1): 48.
[9]	金俊哲, 吴硕东, 张强, 等. 山莨菪碱等对Oddi括约肌作用的临床测压研究[J]. 岭南现代临床外科, 2002, 2(4): 229-231.
[10]	张展峰, 朱社教. 硫酸镁合用丹参注射液治疗胆绞痛和肾绞痛78例[J]. 中国中西医结合急救杂志, 2005, 12(2): 96.
[11]	张晨阳, 陈耀, 林斯航. 大剂量硫酸镁治疗胆囊疾病腹痛52例的效果[J]. 右江医学, 2002, 30(5): 443-444.
[12]	杨宝峰. 药理学[M]. 6版. 北京: 人民卫生出版社, 2005.
[13]	林志彬, 金有豫. 医用药理学基础[M]. 4版. 北京: 世界图书出版公司北京公司, 1998.
[14]	吴林海, 王照东, 耿鑫, 等. 自拟调胆理气汤治疗腹腔镜胆囊切除术后奥迪氏括约肌功能紊乱的临床研究[J]. 卫生职业教育, 2013, 31(18): 148-149.
[15]	周迈, 郭晏同, 常迎彬, 等. 山莨菪碱和加贝酯对胆总管结石术后胆道动力的影响[J]. 世界华人消化杂志, 2009, 17(26): 2748-2751.
[16]	李浩航, 汪建初, 罗宗将, 等. 胆囊结石并肝外胆管结石个体化微创治疗初探[J]. 肝胆胰外科杂志, 2017, 29(5): 417-419.
[17]	吴孟超, 吴在德. 黄家驷外科学[M]. 7版. 北京: 人民卫生出版社, 2008.
[18]	冯变喜. 肝胆胰外科理论与实践[M]. 北京: 科学技术出版社, 2001.
[19]	石继伟. 山莨菪碱对有症状的单个直径≤10 mm胆总管结石排出的促进作用[D]. 承德: 承德医学院, 2017.
[20]	Lefemine V, Morgan RJ. Spontaneous passage of common bile duct stones in jaundiced patients[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(2): 209-213. URL

组别	例数	性别(例)^b		年龄(岁)^a	主要症状体征(例)^b
组别	例数	男	女	年龄(岁)^a	发热	腹痛	黄疸
排石成功组	30	20	10	20~76(49.5±14.5)	5	28	21
排石失败组	11	4	7	26~82(56.0±15.6)	0	10	8
统计值	?	3.045		1.249	1.805
P值	?	0.081		0.219	0.406
组别	胆总管直径(mm) ^a	胆总管结石(例)^b		结石直径(mm)^a	合并疾病(例) ^b
组别	胆总管直径(mm) ^a	单发	多发	结石直径(mm)^a	胆囊结石	急性胆囊炎	胰腺炎
排石成功组	4.7~15.5(9.1±3.2)	28	2	1.6~8.0(4.0±1.5)	19	2	13
排石失败组	7~12(9.1±1.4)	9	2	3.0~7.0(4.9±1.2)	7	5	1
统计值	0.003	1.212		1.638	0.000	6.033	2.812
P值	0.998	0.271		0.11	1.000	0.024	0.094

组别	例数	性别(例)^b		年龄(岁)^a	主要症状体征(例)^b
组别	例数	男	女	年龄(岁)^a	发热	腹痛	黄疸
排石成功组	30	20	10	20~76(49.5±14.5)	5	28	21
排石失败组	11	4	7	26~82(56.0±15.6)	0	10	8
统计值	?	3.045		1.249	1.805
P值	?	0.081		0.219	0.406
组别	胆总管直径(mm) ^a	胆总管结石(例)^b		结石直径(mm)^a	合并疾病(例) ^b
组别	胆总管直径(mm) ^a	单发	多发	结石直径(mm)^a	胆囊结石	急性胆囊炎	胰腺炎
排石成功组	4.7~15.5(9.1±3.2)	28	2	1.6~8.0(4.0±1.5)	19	2	13
排石失败组	7~12(9.1±1.4)	9	2	3.0~7.0(4.9±1.2)	7	5	1
统计值	0.003	1.212		1.638	0.000	6.033	2.812
P值	0.998	0.271		0.11	1.000	0.024	0.094

组别		例数	结石数量(个)	排石时间(d)	住院时间(d)
排石成功组		30	1~3 (1.1±0.4)	3~16 (6.0±3.7)	3~23 (12.7±5.2)
?	单纯胆总管结石	11	1~2 (1.1±0.3)	3~16 (5.5±4.0)	5~23 (12.9±4.9)
?	合并胆囊结石	19	1~3 (1.1±0.5)	3~15 (6.5±3.5)	3~22 (12.5±5.5)
排石失败组		11	1~2 (1.2±0.4)	5~14 (9.4±3.5)	10~23 (15.8±4.1)
t值^a,b		?	0.092, 0.086	0.814, 2.522	0.737, 2.014
P值^a,b		?	0.927, 0.932	0.422, 0.016	0.467, 0.051

组别		例数	结石数量(个)	排石时间(d)	住院时间(d)
排石成功组		30	1~3 (1.1±0.4)	3~16 (6.0±3.7)	3~23 (12.7±5.2)
?	单纯胆总管结石	11	1~2 (1.1±0.3)	3~16 (5.5±4.0)	5~23 (12.9±4.9)
?	合并胆囊结石	19	1~3 (1.1±0.5)	3~15 (6.5±3.5)	3~22 (12.5±5.5)
排石失败组		11	1~2 (1.2±0.4)	5~14 (9.4±3.5)	10~23 (15.8±4.1)
t值^a,b		?	0.092, 0.086	0.814, 2.522	0.737, 2.014
P值^a,b		?	0.927, 0.932	0.422, 0.016	0.467, 0.051

时间	例数	ALT(U/L)	AST(U/L)	TBil(μmol/L)	DBil(μmol/L)	GGT(U/L)	ALP(U/L)
排石前	30	273.5±209.2	209.0±194.7	62.7±45.1	34.2±30.3	338.2±305.8	134.6±70.9
排石后	30	130.9±130.1	46.2±44.7	27.0±14.8	8.1±5.5	199.8±136.5	95.5±52.6
t值	?	3.369	4.957	5.112	5.231	2.264	2.422
P值	?	0.001	0.000	0.000	0.000	0.029	0.019

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