内镜下胆道塑料支架治疗难治性胆总管结石的疗效观察  

Efficacy of endoscopic retrograde billiary plastic stent for intractable choledocholithiasis

作　　者：施云星[1] 曾晓虹[1] 吕礁[1] 周国中[1] 刘长云[1] 覃林花[1] 郑智武[1] 

机构地区：[1]解放军第411医院消化科,上海200081

出　　处：《中国内镜杂志》2012年第7期742-744,共3页China Journal of Endoscopy

摘　　要：目的观察内镜下塑料支架胆道引流术(ERBD)治疗难治性结石的疗效。方法对48例反复腹痛、发热、黄疸、伴基础疾病或因乳头、胆总管异常行乳头括约肌切开术(EST)取石有高风险的难治性胆总管结石病例行ERBD,并随访3～48个月。结果 48例均完成EST+ERBD。术后3d内,腹痛、发热消失,黄疸在1周后明显减轻。48例中有12例ERBD作为长期治疗。2例结石消失。ERBD术3个月后,第2次内镜下结石取净者76.5%(26/34)。17例ERBD术前与术后3个月的MRCP资料显示,胆总管结石直径、胆总管直径缩小显著(P<0.01);且胆总管直径的回缩程度显著大于胆总管结石减小的程度(P<0.01)。结论 ERBD治疗胆总管结石有碎石溶石作用,是治疗难取性胆总管结石简单有效的方法,对高龄伴基础疾病的患者更是明智的选择。[ Objective ] To observe the curative effect of intractable choledocholithiasis by endoscopic retrograde billiary plastic stents placement drainage （ERBD）. [ Method ] ERBD was finished in 48 patients with intractable eholedocholithiasis, who appeared abdominal pain and fever and jaundice again and again when given to endoscopic sphineterotomy （EST）. They had fundamental diseases or high risk for unusual duodenal papilla, choledocholith and were followed up from 3 to 48 months. [ Results ] EST and ERBD were finished for all patients, and abdominal pain or fever vanished in 3 days, and jaundice went down significantly after one week. Using this method common bile duct （CBD） stones vanished in 2 patients. 12 of the 48 patients were treated over a long period of time. 76.5%（26/34） of the patients were eventually cleared stones after second endoscopic treatment. The diameter of eholedocholith and common bile duct shrinked in 17 cases after 3 months （P 〈0.01）. Diameter of common bile duct shrinked better than choledoeholith （P 〈0.01）. [ Conclusion ] ERBD takes effects in soluting and comminuting calculus in the treatment of choledocholithiasis. Placement of billiary plastic stents is a simple and effective procedure in treatment for in- tractable choledocholothiasis. It is a judicious choice to the old or the patients along with basis diseases or intractabe eholedocholithiasis.

关 键 词：难治性胆总管结石 内镜下胆道塑料支架引流术 

分 类 号：R575.7[医药卫生—消化系统]