内镜下经胆管十二指肠乳头瘘口球囊扩张治疗胆总管结石的疗效  

Endoscopic duodenal papillary balloon dilatation via fistula for treatment of patients with common bile duct stones and papillary choledochoduodenal fistula

作　　者：邵东[1] 陈建平[1] 

机构地区：[1]常州市第一人民医院消化科,江苏省常州市213003

出　　处：《世界华人消化杂志》2015年第13期2154-2158,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨内镜下经胆管十二指肠乳头瘘口球囊扩张治疗胆总管结石的有效性及安全性.方法:选取2009-06/2014-10常州市第一人民医院消化科住院治疗并行逆行胰胆管造影术(endoscopic retrograde cholangiopancreato graphy,ERCP)检查患者,其中经ERCP检查提示胆管结石合并十二指肠乳头内瘘患者共28例,分为十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)组和球囊扩张组.结果:所有患者均成功取出结石;EST组有4例取石过程中出现乳头渗血,球囊扩张组有1例扩张后渗血;两组均无术中穿孔发生.在取石时间上,球囊扩张组明显少于EST组(P<0.01);在术中并发症上,球囊扩张组优于EST组(P<0.05).术后并发症比较:EST组轻度腹痛4例、发热1例;球囊扩张组有轻度腹痛1例,无发热情况发生.两组均无迟发型穿孔、出血、重症胰腺炎、化脓性胆管炎发生.两组术后并发症比较,差异有统计学意义(P<0.05).结论:经瘘口直接行气囊扩张治疗胆总管十二指肠乳头内瘘合并胆管结石是安全及有效的.AIM： To evaluate the efficacy and safety of endoscopic duodenal papillary balloon dilatation via fistula in the treatment of patients with common bile duct stones and papillary choledochoduodenal fistula. METHODS： Twenty-eight patients with bile duct stones and papillary choledochoduodenal fistula who received endoscopic retrograde cholangiopancreatography （ERCP） examination from June 2009 to October 2014 at our hospital were divided into either an endoscopic sphincterotomy （EST） group or a balloon dilatation group to receive the two procedures, respectively. Clinical effects were compared for the two groups. RESULTS： Stones were successfully removed in all patients. Bleeding occurred in four patients in the EST group and one in the balloon dilatation group. Perforation did not occur in either group. The operation time was longer in the EST group than in the balloon dilation group （P 〈 0.01）. With regard to intraoperative complications, the balloon dilation group was better than the EST group （P 〈 0.05）. Mild abdominal pain occurred in four patients in the EST group and one in the balloon dilation group. Fever occurred in one patient in the EST group and did not occur in the balloon dilation group. Delayed perforation, hemorrhage, severe acute pancreatitis, and suppurative cholangitis did not occur in either group. Postoperative complications in the two groups were different significantly （P 〈 0.05）. CONCLUSION： Endoscopic duodenal papillary balloon dilatation via fistula for treatment of patients with common bile duct stones and papillary choledochoduodenal fistula is safe and effective.

关 键 词：胆管十二指肠乳头瘘 胆总管结石 乳头 球囊 

分 类 号：R657.4[医药卫生—外科学]