78例乳头旁憩室经内镜乳头括约肌小切开联合短时间气囊扩张术的疗效观察及体会  

The clinical observation and nursing of the 78 patients' with common bile duct stones combined Juxtapapillary diverticulum by the limited endoscopic sphincterotomy plus balloon dilatation

作　　者：靳明华 梁勇 李弘 

机构地区：[1]广西桂林市第二人民医院消化内镜室,广西桂林541001

出　　处：《中国内镜杂志》2015年第6期647-650,共4页China Journal of Endoscopy

摘　　要：目的探讨经内镜乳头括约肌小切开联合短时间(30 s)气囊扩张术治疗十二指肠乳头旁憩室合并胆总管结石的效果和安全性,总结术中配合体会。方法回顾78例十二指肠乳头旁憩室合并胆总管结石的患者,42例乳头括约肌小切开联合短时间气囊扩张术取石为观察组;36例乳头括约肌常规切开取石为对照组,观察取石成功率、术中机械碎石使用率和并发症等。结果观察组取石成功率92.86%,对照组91.67%,机械碎石使用率分别为16.67%和19.44%,两组比较差异无显著性(P>0.05)。观察组出血和穿孔明显少于对照组,尤其是对照组术后高淀粉酶血症与观察组比较差异有显著性(P<0.05)。术后胰腺炎和胆管炎两组相当,差异无显著性(P>0.05)。结论经内镜乳头括约肌小切开联合短时间气囊扩张术治疗十二指肠乳头旁憩室合并胆总管结石,是一种安全、有效的微创治疗方法,对气囊扩张球囊短时间(30 s)注气加压可有效扩张乳头,减少出血、穿孔、疼痛及术后一过性高淀粉酶血症等不良反应发生。【Objective】To investigate the therapeutic efficacy and safety of limited endoscopic sphincterotomy plus balloon dilatation for short time（30 s） in the treatment of the common bile duct stones combined juxtapapillary diverticulum, and summarize the surgery with nursing.【Methods】78 cases with duodenal diverticula combined biliary stones, 42 patients as observation group were treated with limited EST plus short EPBD, and 36 patients conventional EST treatment as control. Rates of stone success, mechanical brokenstone and complications were observed. 【Results】Rate of stone success in treatment group was 92.86%, control group was 91.67%. The rates of mechanical brokenstone were 16.67% and 19.44% in two groups. There was no significantly difference（P〉0.05）.The bleeding and perforation in treatment group was significantly less than the control group, especially the control group with hyperamylasemia were compared with treatment group and the difference was statistically significant between the two groups（P〈0.05）. Rates of two groups were similar in postoperative pancreatitis and cholangitis（P〉0.05）.【Conclusion】Limited endoscopic sphincterotomy plus balloon dilatation for short time treatment common bile duct stones combined juxtapapillary diverticulum is a safe and effective minimally invasive method, the endoscopic papillary balloon dilatation for short（30 s） can effectively expand the duodenal papilla, reduce bleeding, perforation,pain, hyperamylasemia and other adverse reactions. By taking effective and standardized nursing, EST and short EPBD on the common bile duct stones combined juxtapapillary diverticulum have a good effect.

关 键 词：十二指肠乳头旁憩室 胆总管结石 乳头括约肌小切开 乳头气囊扩张术 

分 类 号：R657.44[医药卫生—外科学]