内镜下治疗肝硬化食管胃底静脉曲张并胆总管结石52例  

Endoscopic therapy for choledocholithiasis with liver cirrhosis and esophagogastric varices:An analysis of 52 cases

作　　者：李素萍[1] 薛迪强[1] 杜宏伟[1] 何晓霞[1] 

机构地区：[1]兰州市第二人民医院消化科,甘肃省兰州市730046

出　　处：《世界华人消化杂志》2012年第32期3154-3158,共5页World Chinese Journal of Digestology

基　　金：兰州市科委基金资助项目;No.2012Y0288~~

摘　　要：目的:探讨肝硬化食管胃底静脉曲张并胆总管结石内镜下治疗的疗效及安全性.方法:根据病情对52例肝硬化食管胃底静脉曲张合并胆总管结石患者采用个体化治疗方案.第1组(同步治疗组)曲张静脉硬化栓塞与十二指肠乳头括约肌切开取石术同步进行;第2组(先后治疗组)硬化栓塞治疗曲张静脉10-30d后再行十二指肠乳头括约肌切开取石;第3组(择期治疗组)硬化栓塞治疗曲张静脉及胆道塑料支架置入术后择期行十二指肠乳头括约肌切开取石或十二指肠乳头球囊扩张取石.结果:52例患者中取石成功率为(49/52)94.2%,总体并发症发生率为(5/52)9.62%,消化道出血(2/52)3.85%,胆管炎(2/52)3.85%,急性胰腺炎(1/52)1.92%.2例死于慢性肝功能衰竭,死亡原因与内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatogr aphy,ERCP)无关;1例胆道支架移位,改为外科手术治疗.结论:肝硬化食管胃底静脉曲张并胆总管结石内镜下治疗是目前最佳治疗方法.AIM：To assess the curative effect and safety of endoscopic therapy for choledocholithiasis with liver cirrhosis and esophagogastric varices.METHODS：Fifty-two patients were divided into three groups according to their conditions and treated with individualization regimens.The first group was treated simultaneously by sclerotherapy or embolization of esophagogastric varices and endoscopic sphincterotomy.The second group was treated by endoscopic sphincterotomy 10-30 d after sclerotherapy or embolization of esophagogastric varices.The third group was treated by endoscopic sphincterotomy or endoscopic papillary balloon dilation for choledocholithiasis at the appropriate timeafter sclerotherapy or embolization of esophagogastric varices and endoscopic retrograde biliary drainage（ERBD）.RESULTS：Bile duct stones were removed completely in 49 patients,and the success rate is 94.2%.The incidence of overall postoperative complications was 9.62%（5/52）,and the incidences of cholangitis,hemorrhage,and acute pancreatitis rate were 3.85%（2/52）,3.85%（2/52） and 1.92%（1/52）,respectively.Two patients died of chronic liver failure and the death was not related with the endoscopic procedure.Stent migration occurred in one case and was managed surgically.CONCLUSION：Endoscopic treatment is currently the best treatment for cirrhotic patients with choledocholithiasis and esophagogastric varices.

关 键 词：内镜治疗 胆总管结石 肝硬化 食管胃底静脉曲张 

分 类 号：R575.2[医药卫生—消化系统] R575.7[医药卫生—内科学]