十二指肠乳头旁憩室合并胆总管结石的内镜治疗  

Endoscopic therapy of periampullary duodenal diverticula combined with common bile duct stones

作　　者：许君望[1] 王淑英[1] 宋政军[1] 张素红[1] 孟如意[1] 

机构地区：[1]西安交通大学医学院第一附属医院消化内科,陕西西安710061

出　　处：《中国内镜杂志》2009年第2期116-119,共4页China Journal of Endoscopy

摘　　要：目的探讨诊疗性内镜逆行胰胆管造影术(ERCP)及内镜下乳头括约肌切开术(EST)对十二指肠乳头旁憩室合并胆总管结石治疗的方法及价值。方法回顾性分析48例十二指肠乳头旁憩室合并胆总管结石患者的十二指肠乳头旁憩室与十二指肠乳头的关系及其对ERCP成功率、EST及其并发症的影响。结果该组48例十二指肠乳头旁憩室合并胆总管结石患者,占所发现十二指肠乳头旁憩室的60%(48/80)。ERCP造影成功率97.9%(47/48),47例患者中45例(95.7%)成功施行EST取石。2例EST失败,1例因结石太大网篮圈套困难,另1例因十二指肠变形,内镜难以达到理想位置取石失败转外科手术治疗。该组EST术中创口出血者4例均经局部内镜止血成功,术中及术后无十二指肠穿孔、急性胰腺炎等严重并发症发生,无死亡病例。结论胆道结石发生率与十二指肠乳头旁憩室发生有关。十二指肠乳头旁憩室对ERCP及EST治疗胆管结石的影响是有限的,只要操作者耐心、细心,十二指肠乳头旁憩室合并胆管结石经内镜下取石仍是一种安全、有效的治疗手段。ObjectiveTo investigate the curative methods and value of endoscopic retrograde cholangiopancre-atography （ERCP） and endoscopic sphincterotomy （EST） for periampullary duodenal diverticula combined with com-mon bile duct stones. MethodsRelationship between periampullary diverticula and duodenal papilla in 48 pa-tients of periampullary diverticula combined with common bile duct stones, and its effect on success rate of ERCP, EST and complications were analyzed retrospectively.ResultsPeriampullary diverticula was present in 80 patients underwent therapeutic ERCP, of which 60% （48/80） were complicated with calculus of bile duct, success rate of ERCP was 97.7% （47/48）, and the stones were removed successfully by EST in 45 of 47 patients （95.7%）. EST failed in 2 cases because of huge bile duct stones or duodenal warp. Four of the patients with slight hemorrhage after EST and had been hemostasis by endoscopic injection immediately, there were no serious complications including perforation, acute pancreatitis and death happened after treatment. ConclusionThe periampullary diverticula is prone to be complicated with calculus of bile duct, which makes therapeutic ERCP and EST a little more difficult and risky. However, as long as the operator is patient and cautious, therapeutic ERCP and EST can be safely and effectively performed.

关 键 词：十二指肠乳头旁憩室 胆总管结石 内镜逆行胰胆管造影术 内镜十二指肠乳头括约肌切开术 

分 类 号：R656.64[医药卫生—外科学]