45例老年人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 in the 45 aged people

作　　者：汪发勇[1] 潘宏年[1] 蒋宇敏[1] 李婷[1] 

机构地区：[1]安徽医科大学附属六安医院消化科,安徽六安237005

出　　处：《安徽医药》2012年第7期958-960,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨内镜治疗老年人十二指肠乳头旁憩室合并胆总管结石的疗效。方法回顾性分析2006年6月—2011年5月45例老年人十二指肠乳头旁憩室合并胆总管结石的内镜治疗临床资料。对44例老年患者行内镜下十二指肠乳头括约肌切开术(EST)和(或)气囊扩张术,并行网篮取石或机械碎石后网篮取石。结果所有病例插管造影成功均显示胆总管结石,结石直径在0.6～3.0 cm。其中单发结石27例,2枚结石12例,三枚以上6例。网篮直接取石34例,碎石后取石7例,3例胆总管放置塑料支架,1例因乳头太小无法行切开同时结石较大转手术治疗。一次取尽结石35例,放置鼻胆管引流后二次取石6例。3例术中乳头肌切开渗血,给予电凝、局部喷洒去甲肾上腺素或气囊压迫出血停止,1例24 h后乳头切口涌血,给予钛铗止血。2例出现术后轻症胰腺炎,5例出现一过性高淀粉酶血症,给予相应处理痊愈。对其中36例随访6～12个月未见结石复发,3例放置塑料支架患者半年后结石明显变小,再次内镜治疗。结论老年十二指肠乳头旁憩室合并胆总管结石的内镜治疗是相对安全有效,内镜治疗应根据憩室位置和结石大小选择合适的乳头切开长度,结合气囊扩张、碎石等方法,可避免并发症发生。Objective To explore the efficacy of endoscopic therapy of periampullary duodenal diverticula combined with common bile duct stones in the aged people. Methods From June 2006 to May 2011 45 aged people of periampullary duodenal diverticula combined with common bile duct stones were analyzed. Toally 44 patients underwent endoscopic sphincterotomy（EST） or combined with balloon dilatation, endoscopic lithotripsy basket or/（and） mechanical lithotripsy to remove the common bile duct stones. Results The diagnosis of common bile duct stones was conformed during the successful operation in all the cases successfully. Diameter of stones between 0.6 cm and 3.0 cm,27 patients had one stone, 12 had two and 6 had three or more. The stones were removed using basket directly in 34 patients,7 patients were selected with Endoscopic mechanical lithotripsy（EML） ,and plastic stent placement without calculus removal in 3 patients. EST failed in one patient because of small duodenal papilla and huge stone. The stones were removed completely at the first opration in 34 cases, and the other 6 cases received a second operation after endoscopic nasobiliary drainage. Errhysis occurred in 3 patients during opration and was healed by locally sprinkling noradrenaline or electric coagulation. One patient had hemorrhage from the incision on the duodenal papilla 24 hours after the operation and was cured by using clipper. 2 patients developed mild pancreatitis,5 patients had a transient increase of serum amylase. They were cured by some medical methods. Thirty-six of the patients were followed up for 6 to 12 months, when common bile duct stones didn＇t reocccur. The stones became smaller in 3 patients with plastic stent and received endoscopic therapy again. Conclusion In the aged people, endoscopic therapy of periampullary duodenal diverticula combined with common bile duct stones is relativly safe. Proper cut should be choose according to the location of diverticula, the size of the stones, use for balloon dilatation and endoscopi

关 键 词：老年人 十二指肠乳头旁憩室 胆总管结石 内镜治疗 

分 类 号：R657.4[医药卫生—外科学]