乳头括约肌小切开加大口径气囊扩张术治疗胆总管结石的价值  

THE VALUES OF MINOR ENDOSCOPIC SPHINCTEROTOMY PLUS LAREG-DIAMETER BALLOON DILATATION FOR REMOVAL OF COMMON BILE DUCT STONES

作　　者：苏进根[1,2] 王建平[1,2] 陈跃宇[1,2] 陆奕宁[1,2] 陆惠清[1,2] 施凤娟[1,2] 

机构地区：[1]上海交通大学附属仁济医院嘉定分院 [2]嘉定区中心医院普外科,上海201800

出　　处：《肝胆外科杂志》2012年第5期340-342,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨采用括约肌小切开加大口径气囊扩张(ESBD)治疗胆总管结石的有效性与安全性。方法将104例肝外胆管结石且胆管直径>13 mm的患者,随机分成2组各52例,EST组采用单纯乳头大切开;ESBD组在乳头括约肌小切开后用直径15 mm的柱状气囊扩张,2组再行相应的碎石或取石操作。观察2组病例的结石清除率、取石时间、碎石器使用率及并发症等情况。结果 2组病例的胆管结石大小、数量以及乳头旁憩室的发生率相似;EST组和ESBD组Ⅰ期结石清除率分别为94.2%和96.2%(P=1.000),取石时间分别为(30.38±10.51)min和(26.31±8.59)min(P=0.033),碎石器的使用率分别为28.8%和11.5%(P=0.028),取石次数分别为19和10(P=0.049)。EST组发生并发症5例(轻度胰腺炎3例、中度出血2例),ESBD组发生轻度胰腺炎3例,差异无统计学意义,且均无死亡病例。结论内镜下括约肌小切开加大口径气囊扩张是清除肝外胆管结石的有效方法,尤其适合于胆总管巨大结石或行乳头切开取石困难者。Objective To investigate the efficiency and safety of endoscopic ninor sphincterotomy plus large balloon dilatation （ESBD） for treatment of common bile duct （CBD） stones. Methods 104 Patients with extra-hepatic bile duct stones and with the di- ameter of CBD larger than 13 mm were randomly divided into 2 groups with 52 patients in each to receive maximal sphincterotomy （ EST group） , or ESBD group respectively, followed by conventional stones removal and/or lithotripsy. The successful rate of stone clear- ance, operation time, the rate of mechanical lithotripsy and related complications were observed. Results The sizes and quantities of calculi, and incidences of peri-ampullary diverticulum of patients in both groups were all similar. Stones clearance with single session in 2 groups were 94. 2% and 96. 2% respectively （P = 1. 000 ）. The stone - removal time were （30. 38 ± 10. 51 ） min and （26. 31 ± 8.59） min （P = 0. 033 ）. The rate of mechanical lithotripsy were 28. 8% and 11.5% respectively （P = 0. 028 ）. The frequency of stone removal were 19 and 10 respectively （P = 0. 049）. Complications occurred in 5 eases in EST group （3 mild pancreatitis, 2 moderate hemorrhage） , and 2 mild pancreatitis occurred in ESBD group （no statistical difference）. No death happened in any group. Conclusion ESBD is an effective and safe method for clearance of extra-hepatic bile duct stones, and an optimal alternative for those with large stones or difficult sphincterotomy especially.

关 键 词：胆总管结石 内窥镜 括约肌切开术 气囊扩张术 

分 类 号：R657.4[医药卫生—外科学]