十二指肠乳头气囊扩张术与十二指肠乳头括约肌切开术治疗肝外胆管结石的近期疗效观察  

The Effect of Endoscopic Papillary Ballon Dialation (EPBD) and Endoscopic Sphincteroto-my (EST) in the Treatment of Extahepatic Bile Duct Stone

作　　者：王若燕[1] 李峰[1] 季圣昉[1] 

机构地区：[1]同济大学附属东方医院内镜中心,上海200120

出　　处：《中国临床医学》2005年第3期458-460,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨内镜下十二指肠乳头气囊扩张术(EPBD)与十二指肠乳头括约肌切开术(EST)在治疗肝外胆管结石时的安全性和疗效。方法:(1)实施EPBD68例,应用气囊将十二指肠乳头开口扩张至8-10mm,直接用取石网篮或取石气囊取石。其中63例在EPBD后当即清除结石(9例在EPBD后再行EST取石);3例7-10d后在十二指肠镜下再次行EPBD取尽残余结石;2例改行外科手术取石。(2)实施。KST63例,应用拉式切开刀对乳头作12-15mm切开后取石。其中59例用取石网篮及取石气囊当即清除结石(其中7例附加碎石网篮碎石后取石);2例7-10d后在十二指肠镜下再次取尽残余结石;2例改行外科手术取石。结果:68例完成EPBD的病例中,无出血、穿孔、胆管炎及重症胰腺炎发生。63例完成EST的病例中,无穿孔发生;胆管炎2例,出血2例,重症胰腺炎1例。9例在EPBD后再行EST取石的病例,无出血、穿孔、胆管炎及重症胰腺炎发生。结论:EPBD联合EST取石可提高取石的成功率,且胰腺炎的发生率较单纯EST显著降低,发生出血、穿孔的风险也明显降低;EPBD联合EST取石,出血风险及胰腺炎的发生率与单纯EPBD比较无明显差异。Objective: To evaluate the efficacy and safety between endoscopic papillary ballon dialation (EPBD) and endoscopic sphincter-otomy (EST). Methods: (1). In 68 cases of EPBD, the paplilla was dialated with the ballon which is about 8-10mm diameter, the stone was removed with retrieval basket or ballon. 63 cases of the above, the stones were removed right after EPRD;(9 cases were removed stones by EST after EPBD);3 cases of the above, theremain stones were removed 7-10 days after EPBD; 2 cases were removed stones by surgery. (2). In 63 cases by EST, cutted the papilla about 7-15mm diameter. 59 cases of the above were removed the stones by retreival basket or ballon right after EPBD. and 7 cases with wire lithotriptor in addition; 2 cases were removed remain stones after 7-10 days; 2 cases were removed stones by surgery. Results: In 68 cases of EPBD, there is no pancreatitis, bleeding or perforation. In 63 cases of EST, there is no perforation, with chohthiasis in 2 cases, bleeding in 2 cases and pancreatitis in 1 cases. 9 cases with EST after EPBD, there were no bleeding perforation, cholithiasis and pancreatitis. Conclusion:EST is more effective compared to EPBD in treating bile duct stone; Removing stones by EST after EPBD is the same effective while less complications compared to EST; There is no significant difference in complications between EPBD and EPBD combined EST.

关 键 词：经内镜十二指肠乳头气囊扩张术 经内镜十二指肠乳头括约肌切开术 胆总管结石 并发症 

分 类 号：R657.42[医药卫生—外科学]