内镜十二指肠乳头小切开联合气囊扩张治疗伴壶腹部憩室的胆总管大结石的价值研究  

Limited endoscopic sphincterotomy plus balloon dilation （ESBD） for large choledocholithiasis accompanied with periampullary diverticula

作　　者：曾冉冉 孙刚[1] 张修礼[1] 蔡逢春[1] 李闻[1] 黄启阳[1] 令狐恩强[1] 杨云生[1] 

机构地区：[1]解放军总医院消化病中心,北京100853

出　　处：《中华消化内镜杂志》2015年第5期281-285,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜十二指肠乳头小切开联合气囊扩张术治疗伴壶腹部憩室的胆总管大结石的安全性和有效性。方法回顾性分析40例十二指肠乳头小切开联合气囊扩张术治疗伴壶腹部憩室的胆总管大结石（直径≥10mm）患者的临床特征、手术方法、取石成功率和近期并发症等，并对憩室内乳头和憩室旁乳头患者进行分组比较。结果40例患者中位操作时间29min，一次性取石成功率达90．0％（36／40）。其中3例残留结石经二次取石成功，总体取石成功率97．5％（39／40）。术后近期并发症发生率15％（6／40），其中轻型胰腺炎2例、高淀粉酶血症2例、术后迟发出血2例，均保守治疗后好转，无消化道穿孔、大出血及死亡病例。两种类型憩室患者的取石成功率和并发症差异无统计学意义。结论对合并壶腹部憩室的胆总管大结石，内镜十二指肠乳头小切开联合气囊扩张术具有良好的安全性和有效性，且憩室类型对疗效无明显影响。Objective To explore the effectiveness and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation （ESBD） for patients with large common duct stones and periampullary diverticula （PAD）. Methods Data of 40 patients with large common duct stones （diameter ≥ 10 mm） and PAD who underwent ESBD were retrospectively reviewed. The clinical feature, operation method, success rates of stone removal and early complications rates during hospitalization were evaluated according to PAD subtypes. Results The stone removal rate in first session was 90. 0% （ 36/40, with a median time of 29 minutes per procedure. Three patients underwent a second procedure to remove residual stones. The overall stone removal rate was 97. 5% （39/40）. The early complications rate was 15% （6/40） ,including mild panereatitis in two cases（5% ）, hyperamylasemia in two （5%）, postoperative late bleeding in two （5%）, which were cured with conservative treatment. No perforation, massive hemorrhage or death occurred. No significant differences in success stone removal rate and early complication rate were found between PAD subtypes. Conclusion ESBD is an effective and safe procedure for removing choledocholithiasis in patients with PAD, regardless of PAD subtypes.

关 键 词：胰胆管造影术 内窥镜逆行 括约肌切开术 内窥镜 胆总管大结石 壶腹部憩室 气囊扩张术 

分 类 号：R657.4[医药卫生—外科学]