A Grading System for Assessing the Status of the Sphincter of Oddi During Intraoperative Choledochoscopy: A Surgeon's Perspective.

Hai Chuan Chen, Zhe Jin Wang, Hong Liang Song
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Abstract

Background: The aim of this study was to establish a simple and practical grading system for evaluating the status of the sphincter of Oddi (SO) during intraoperative choledochoscopy. This system helps identify relevant variables that influence the status of the SO and provides recommendations for preventing stone recurrence.

Methods: Ninety-three patients were selected retrospectively from a total of 316 patients diagnosed with choledocholithiasis between July 2020 and June 2023. All patients underwent common bile duct (CBD) exploration surgery and intraoperative choledochoscopy. The status of the SO was assessed during choledochoscopy. According to the severity of the condition, the patients were categorized into 4 groups. Data from each group, grades 1, 2, 3, 4, was analyzed statistically.

Results: The number of patients in grade 1 was significantly lower than that of the other 3 groups. Except for grade 1, patients in grade 4 exhibited significant differences compared with the other 2 groups in terms of the diameter of the CBD, size of stones, presence of pneumobilia, and history of endoscopic retrograde cholangiopancreatography (ERCP) ( P <0.05). There were no significant differences between the groups in terms of sex, age, liver function, number of stones, history of gastrectomy, cholecystectomy, or CBD exploration.

Conclusions: The grading system helps us classify different sphincter functions and better understand the formation of choledocholithiasis by subdividing the status of the SO. Endoscopic sphincterotomy (EST) treatment can easily result in the loss of SO function, which increases the risk of stone recurrence.

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术中胆道镜检查时评估奥狄氏括约肌状态的分级系统:外科医生的视角。
背景:本研究旨在建立一套简单实用的分级系统,用于在术中胆道镜检查时评估奥狄氏括约肌(SO)的状态。该系统有助于确定影响奥狄氏括约肌状态的相关变量,并为预防结石复发提供建议:从2020年7月至2023年6月期间确诊的316名胆总管结石患者中回顾性地挑选出93名患者。所有患者均接受了胆总管(CBD)探查手术和术中胆道镜检查。胆道镜检查过程中评估了SO的状态。根据病情严重程度,患者被分为四组。对每组(1、2、3、4级)的数据进行统计分析:结果:1 级患者人数明显少于其他 3 组。除 1 级患者外,4 级患者在 CBD 直径、结石大小、有无积气、有无内镜逆行胰胆管造影术(ERCP)病史等方面均与其他 2 组患者存在显著差异(PConclusions:该分级系统有助于我们对不同的括约肌功能进行分类,并通过细分括约肌的状态更好地了解胆总管结石的形成。内镜下括约肌切开术(EST)治疗很容易导致括约肌功能丧失,从而增加结石复发的风险。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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