内窥镜治疗胆胰疾病746例的临床观察

目的 探讨内窥镜下十二指肠乳头括约肌切开术对胆总管结石及缩窄性乳头炎的治疗作用。方法 总结1987年7月至2001年5月间实施的746例次内窥镜十二指肠乳头括约肌切开术的经验。结果 EST治疗胆总管结石572例，结石排出538例(94．1％)；缩窄性乳头炎174例，成功165例(94．8％)；因缩窄性乳头炎至慢性胰腺炎者45例，症状缓解40例(88．9％)。内窥镜十二指肠乳头括约肌切开术后发生重症胰腺炎、切口出血等并发症16例(2．2％)，本组无死亡病例。结论 采用内镜治疗胆总管结石及缩窄性乳头炎是一种理想的微创外科方法。     

经内镜乳头括约肌切开(EST)治疗胆总管结石326例临床分析

目的 探讨内窥镜下十二指肠乳头括约肌切开术(EST)对胆总管结石的治疗效果.方法 总结1990年10月至2009年1月间实施的326例次内窥镜十二指肠乳头括约肌切开(EST)治疗胆总管结石的经验,并对其中195例病人进行长期随访.结果 EST治疗胆总管结石326例,结石排出301例(92.3%).内窥镜十二指肠乳头括约肌切开术后发生并发症20例(6.13%),其中急性胰腺炎10例(3.07%),术后出血7例(2.14%),急性胆管炎4例(1.22%),十二指肠穿孔1例(0.09%),病死1例.随访结果,发生反流性胆管炎20例(10.25%),结石复发18例(9.23%).结论 经内镜括约肌切开治疗胆总管结石创伤小、安全性高、疗效满意、术后恢复快,是一种理想的微创外科方法.     

经内镜乳头括约肌切开术治疗胆总管结石临床研究

目的探讨经内镜乳头括约肌切开术(EST)治疗胆总管结石的临床效果。方法对256例胆总管结石(9~15mm)患者采用经内镜乳头括约肌切开术(EST)治疗。结果EST取石成功249例,成功率97.3%,其中221例一次取净结石,28例2~3次取净结石,7例取石未成功。EST术后发生并发症16例,总发生率6.3%,其中急性胰腺炎10例,急性胆管炎5例。结论经内镜乳头括约肌切开术治疗胆总管结石是一项安全可靠的新技术。     

内镜下胆总管结石合并十二指肠乳头旁憩室治疗方式的选择

目的 探讨内镜下胆总管结石合并十二指肠乳头旁憩室治疗方式的选择.方法 对143例胆总管结石合并十二指肠乳头旁憩室患者分别运用内镜下乳头括约肌切开术（EST）、乳头扩张术（EPBD）和乳头括约肌切开术联合乳头扩张术（EST＋EPBD）,并辅以取石篮、取石球囊、鼻胆管和碎石篮机械碎石进行取石.结果 43例患者行EST术,42例成功取石,并发出血4例、穿孔2例、急性胰腺炎1例、结石复发1例;39例患者行EPBD术,38例成功取石,并发出血1例、急性胰腺炎5例、结石复发2例;61例患者行EST＋EPBD术,59例成功取石,并发急性胰腺炎1例、结石复发2例,无出血、穿孔患者.共4例取石失败,1例因直径大于3 cm,2例因胆总管结石充满,1例因行毕Ⅱ式吻合后镜身不够长转外科手术治疗.所有并发症均经保守治疗治愈.结论 内镜下运用乳头括约肌切开术联合乳头扩张术对胆总管结石合并十二脂肠乳头旁憩室治疗是一种微创、安全、有效的首选治疗手段.     

腔镜胆总管切开术与内镜联合腹腔镜治疗胆总管结石的临床分析

目的对腹腔镜胆总管切开术与内镜联合腹腔镜治疗胆囊结石合并胆总管结石的疗效进行比较和评价。方法回顾性分析2002年7月至2007年7月，20例行腹腔镜胆囊切除、胆总管探查（LCD组），15例行腹腔镜胆囊切除联合内镜乳头括约肌切开取石术（EST＋LC组）患者的手术及术后情况。结果LCD组近期并发症发生率低于EST＋LC组（20％ vs 5％，P〈0．05），LCD组平均住院日和平均住院费用均明显低于EST＋LC组（P〈0．05），手术成功率两组差异无统计学意义（P〉0．05）。结论腹腔镜胆总管切开术是治疗胆囊结石并胆总管结石疗效肯定的微创手术。     

腔镜胆总管切开取石与内镜乳头括约肌切开取石的临床比较

目的探讨腹腔镜胆总管切开取石术（LCBDE）治疗胆总管结石的可行性。方法回顾分析238例胆总管结石患者的临床资料。行内镜乳头括约肌切开取石术（EST）125例，LCBDE 113例，比较两组疗效及并发症。结果术后住院日、手术时间、手术成功率及结石残留率、术后近期并发症发生率差异均无显著性（P〉0．05）；远期并发症两组间差异有统计学意义（P〈0．05）；EST组结石复发14例（11．2％），乳头狭窄9例（7．2％），胆管炎13例（10．4％）；LCBDE组结石复发4例（3．5％），胆管炎2例（1．8％），无乳头狭窄。结论LCBDE治疗胆总管结石的远期疗效优于EST，是一种合理的手术方法。     

LC联合内镜EST治疗胆囊结石合并继发胆总管结石的临床研究

目的探讨腹腔镜胆囊切除术（LC）与内镜十二指肠乳头括约肌切开术（EST）联合应用治疗胆囊结石合并胆总管结石的临床效果。方法全组患者先行EST，在B超引导下使用取石网篮取干净总胆管结石，取石后常规放置ENBD管，1周后行鼻胆管造影明确胆总管无结石后行LC治疗。结果全组20例均获得成功，无中转开腹及严重并发症。结论LC与EST联合应用治疗胆囊结石合并胆总管结石，有较好的疗效，具有创伤小、效果好、并发症少、恢复快等优点。     

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目的 探讨内镜在重症急性胆管炎（ACST）急诊治疗中的应用价值。方法 自1997年1月至2002年5月应用十二指肠镜急诊治疗重症急性胆管炎。对于乳头部结石嵌顿用针型刀切开乳头、插管困难者先行乳头括约肌切开术。选择直径＜1.2cm的1－2颗胆总管结石行经内镜括约肌切开术（EST），网篮取石放置鼻胆引流管（ENBD），其余直接行鼻胆引流管引流。结果 156例ACST中148例ENBD治疗成功，内镜治疗成功率94．9％。125例ENBD治疗后24小时内症状减轻。所有良性病变（胆总管结石、胆管良性狭窄）均得到有效引流，5例胆道恶性肿瘤由于胆管的多处狭窄引流失败。平均引流时间为7.3天（1－25天）。无一例消化道穿孔和死亡，术后5例出现急性轻型胰腺炎，3例乳头出血，总的并发症发生率5．1％。结论 急诊内镜治疗ACST操作简便，安全有效，尤其适用于高龄、一般情况较差、肝硬化凝血功能障碍和多次胆道手术病人。     

腹腔镜、十二指肠镜联合治疗胆囊结石合并胆总管结石的临床分析

目的总结应用十二指肠镜下乳头括约肌切开术（endoscopicsphincterectomy,EST）联合腹腔镜胆囊切除术（1aparoscopiecholecystectomy,LC）选择性治疗胆囊结石合并胆总管结石的经验。方法对23例胆囊结石合并胆总管结石患者采用EST联合LC序贯治疗。先行EST取出胆总管结石,再于2—5d内行LC。结果22例（96％）成功施行EST,1例失败,22例成功完成Lc,无中转开腹手术。手术时间EST25～50rain,LC40～60min,住院7—18d,平均11．8d。22例随访3～36个月,平均17个月,无结石复发及严重并发症发生。结论EST联合LC是治疗胆囊结石合并胆总管结石的安全、合理、有效的首选微创方法。     

内镜氩等离子凝固术治疗十二指肠乳头切开出血1例报告

本文报道我院1例肝移植术后并发胆总管结石患者，经内镜下十二指肠乳头切开术（endoscopic sphincterotomy，EST）、胆总管取石术后十二指肠乳头顽固渗血，应用内镜下氩等离子凝固术（argon plasma coagvlation，APC）治疗，取得了较好的疗效。     

超声引导下经十二指肠镜治疗老年胆总管结石

目的探讨超声引导下经十二指肠镜治疗老年胆总管结石的临床价值。方法对48例60岁以上胆总管结石患者行超声引导下经十二指肠镜乳头肌切开及取石术（EST）。术后经超声及X线下内镜逆行性胆胰管造影（ERCP）观察治疗效果。结果48例患者中超声引导下经十二指肠镜取石一次成功43例，二次取石成功3例，共取出完整结石51粒，结石大小为0．8～2．1cm，取石总成功率为95．83％（46／48）。结论超声引导下经十二指肠镜治疗胆总管结石不需麻醉、创伤小、痛苦少、术后恢复快，取石成功率高,对老年患者尤其是一种安全有效的治疗方法。     

Endoscopic methods in the treatment of the obturation of the papilla magna duodeni

Endoscopic methods of treatment were applied in 320 patients with the duodenal papilla magna (DPM) obturation. After performance of endosurgical correction of the bile outflow the pain disappeared in 54%, subsided significantly in 38% patients. In 48 patients endoscopic suprapapillar choledochoduodenostomy was performed, cryodestruction of tumor--in 17 for cancer affection of DPM. In 197 patients with wedged ampullar DPM calculus the atypical papillosphincterotomy was performed successfully. Three (0.9%) patients died.     

Endoscopic papillosphincterotomy in the treatment of choledocholithiasis

The article analyzes an experience with endoscopic papillosphincterotomy in 45 patients with recurrent or residual choledocholithiasis with/without stenosis of the major duodenal papilla. In 38 pathients stones were removed after endoscopic papillosphincterotomy or were eliminated spontaneously. In later terms none of the patients showed restenosis of the major duodenal papilla. Thus, endoscopic papillosphincterotomy is considered to be an effective method of treatment of choledocholithiasis.     

Endoscopic methods in the diagnosis and treatment of mechanical jaundice of non-neoplastic etiology

The authors analyse the results of treatment of 255 patients with obstructive jaundice of nonneoplastic origin. Various endoscopic methods were used. Endoscopic interventions were carried out in the first two days in 79.8% of cases. Laparoscopic cholecystostomy was conducted in 138 patients; jaundice was relieved in 3 to 20 days in 95% of cases. It is shown that the best results of operative treatment of patients with acute cholecystitis complicated by choledocholithiasis are produced in concurrent use of laparoscopic cholecystostomy and endoscopic papillosphincterotomy.     

Duodenoscopic interventions on the terminal part of the choledochus]

The results of various methods of duodenoscopic interventions on the terminal choledochus in 261 patients with papilla stenosis and choledocholithiasis were analysed. Endoscopic papillosphincterotomy by the cannulation method was performed in 107 patients, endoscopic papillosphincterotomy with preincision of the major duodenal papilla in 31, and endoscopic suprapapillary choledochoduodenostomy in 123 patients. The performance of various methods of duodenoscopic interventions according to indications made it possible to increase the possibility of conducting the operation to 98% and its efficacy to 95%. Complications after duodenoscopic interventions occurred in 10% of cases with 1.2% lethality. The late results of duodenoscopic interventions were good in 85.5% of cases irrespective of the mode of the operation.     

Laparoscopic cholecystectomy in choledocholithiasis and stricture of the terminal part of the common bile duct

The authors offer the treatment and diagnostic algorithm in choledocholithiasis, stricture of a terminal portion of the common hepatic duct and papilla stenosis revealed in laparoscopic cholecystectomy (LCE). With the purpose of intraoperative assessment of bile ducts states during LCE, the diagnostic system including laparoscopic and ultrasonic examinations, cholangiography and choledochoscopy was developed and applied. In intraoperative revealing of choledocholithiasis without bile outflow disorders and wide cystic duct the authors prefer to remove the concrements during choledochoscopy through cystic duct without intervention on Vater's papilla (VP). In combination of choledocholithiasis with bile outflow disorders and also in isolated papilla stenosis and stricture of a terminal portion of the common hepatic duct, one-stage laparoscopic cholecystectomy, intraoperative antegrade papillosphincterotomy and retrograde calculus extraction is optimal. In cases when complete endoscopic calculus extraction is impossible, the drainage of the common hepatic duct by Cholsted's with subsequent delayed endoscopic papillosphincterotomy (EPST) is acceptable. During intraoperative examination in 49 patients (57.6%) the concrements in choledochus, not diagnosed earlier, were revealed, in 21--stricture of terminal choledochus portion and in 19 patients--papilla stenosis. In 12 cases the concrements were removed during choledochoscopy through the cystic duct stump, 4 patients with big concrements required laparoscopic choledocholithotomy. In 16 cases LCE with various variants of choledochus drainage was performed as the first stage, as the second stage--EPST and lithoextraction. Antegrade papillosphincterotomy was performed in 15 patients during LCE. In 12 cases intraoperatively revealed choledocholithiasis combined with papilla stenosis (7) and choledochus stricture (5) was the indications to intraoperative papillosphincterotomy. Papilla stenosis was the indication to antegrade papillosphincterotomy in 3 patients.     

内镜治疗急性胆源性胰腺炎的临床价值

目的探讨内镜治疗急性胆源性胰腺炎的疗效。方法对我院1998年7月~2004年10月行ERCP、EST、ENBD等方法治疗急性胆源性胰腺炎43例的临床资料进行回顾性分析。结果本组43例经内镜治疗后疗效均满意。术后发生出血1例、形成胰腺假性囊肿2例、死亡1例。无因病情恶化而中转手术治疗者。结论ERCP对急性胆源性胰腺炎的诊断有重要价值;内镜是治疗急性胆源性胰腺炎安全、有效的方法之一。     

Endoscopic examination for diagnosis of cancer of major duodenal papilla

Endoscopic procedures were used for diagnosis and treatment of cancer of major duodenal papilla (MDP) at 31 patients. Gastroduodenoscopy (with visual assessment) and endoscopic retrograde cholangiopancreatography were performed at all the patients. Morphological study of tissue sampling permitted to confirm preliminary visual diagnosis only in half of patients. Detection of x-ray symptoms and bile passage disorders at retrograde cholangiopancreatography were high informative. All the patients underwent endoscopic papillosphincterotomy which was effective at 26 (83.9%) patients.     

Improvement of endoscopic treatment of the acute cholecystitis

Treatment results of 763 patients with acute cholecystitis were analyzed. Destructive forms of the disease was diagnosed by the ultrasound examination in all cases. Choledocholithiasis was diagnosed in 35 (4.6%), choledocholithiasis with papilla Vatery stricture was in 9 (1.2%) patients and isolated papilla Vatery stricture was registered in 5 (0.7%) patients. All patients were attempted to treat laparoscopically with the use of original "Device for antegrade papillotomy" and "Method of antegrade bipolar papillosphincterotomy". Authors state, that a final decision about the possibility of endoscopic treatment of the acute cholecystitis can be made after detection of anatomical structures of the Calo triangle. By complicated forms of the disease a one-stage laparoscopic treatment should be preferred. Endoscopic papillosphincterotomy should be performed only by the enblocked concrement of the papilla Vatery.     

Endoscopic transpapillary methods of choledocholithiasis treatment, caused by presence of multiple calculi

The results of endoscopic transpapillary surgical interventions in 115 patients, suffering choledocholithiasis, caused by the multiple calculi presence, were analyzed. The patients were divided on four groups, depending on the treatment provided. In 78 patients (first group) endoscopic papillosphincterotomy with mechanical lithoextraction in conjunction with spasmolytic and infusion therapy were performed. In 16 patients (second group) endoscopic papillosphincterotomy with mechanical lithotripsy and partial lithoextraction, endobiliary stenting with further spasmolytic and infusion therapy were performed. In 11 patients (the third group) endoscopic papillosphincterotomy, mechanical lithotripsy with a partial lithoextraction and nasobiliary drainage were used. In 10 patients (the fourth group) endoscopic papillosphincterotomy, mechanical lithotripsy, nasobiliary drainage and endobiliary stenting were applied. The best results were achieved in the first group: the smallest duration of the operation--(32.2 +/- 12.6) min, the smallest stationary state duration--(3.3 +/- 1.2) days, the lowest rate of intraoperative complications--2.6%.