ENBD预防胆总管结石ERCP术后急性胰腺炎及高淀粉酶血症的临床价值

目的观察内镜鼻胆管引流术(ENBD)预防内镜逆行胰胆管造影术(ERCP)术后急性胰腺炎及高淀粉酶血症的效果。方法收集我院胆总管结石行ERCP取石术的患者367例,其中ENBD组309例,对照组58例,比较两组术后2 h及24 h血清淀粉酶值、高淀粉酶血症及急性胰腺炎的发生率。结果 ENBD组术后2 h、24 h的血清淀粉酶值分别为(396.6±240.3)U/L和(620.8±345.5)U/L,明显低于对照组的(593.9±470.5)U/L和(1 074.0±609.1)U/L(P<0.05);ENBD组有42例发生高淀粉酶血症(13.6%)、15例发生急性胰腺炎(4.9%),对照组则分别为13例(22.4%)和8例(13.8%),两组比较差异均有统计学意义(P<0.05)。结论 ENBD能有效预防胆总管结石患者ERCP术后急性胰腺炎及高淀粉酶血症的发生。     

Risk factors for acute pancreatitis after endoscopic papillary balloon dilation

BACKGROUND/AIMS: Although EPBD (endoscopic papillary balloon dilation) may cause acute pancreatitis, risk factors for post-EPBD pancreatitis have not been well described. We retrospectively analyzed risk factors predictive of acute pancreatitis after EPBD. METHODOLOGY: A total of 101 patients underwent EPBD for choledocholithiasis. Post-EPBD acute pancreatitis was investigated. Nineteen potential risk factors, related to clinical characteristics or procedures, were retrospectively analyzed univariately and multivariately. RESULTS: Bile duct clearance was achieved in 96 patients. Serum amylase was elevated after EPBD in 69 patients. Early complications occurred in 11 patients (11%); 5 had minimal (pain persisting for only 12-24 hours) and 6 mild (requiring 1-3 days of treatment) pancreatitis. These 11 patients showed at least a three-fold elevation of serum amylase. Multivariate analysis identified two independent risk factors for pancreatitis (prior history of acute pancreatitis, and bile duct diameter < or = 9 mm). The risk for post-EPBD pancreatitis was not associated with young age, pre-EPBD hyperamylasemia, large or multiple stones, periampullary diverticulum, pancreatic contrast injection, mechanical lithotripsy or residual stones. CONCLUSIONS: Acute pancreatitis, usually mild or minimal, can be anticipated after EPBD for bile duct stones in approximately 10% of patients. In those with previous pancreatitis or a non-dilated bile duct, special care is necessary given the high incidence of pancreatitis.     

Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty

BACKGROUND: AND AIM: Endoscopic balloon sphincteroplasty (EBS) is an alternative to sphincterotomy for the treatment of bile duct stones. The purpose of this study was to determine if epinephrine irrigation of the papilla can prevent the pancreatic damage associated with EBS. METHODS: A total of 173 patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography, EBS was performed by using a biliary dilatation catheter (balloon diameter: 8 mm). The duct was then cleared by using Dormia baskets or retrieval balloon catheters. Mechanical lithotripsy was performed before extraction when the stones were greater than 8 mm in diameter. In 81 patients, the dilated orifice was irrigated with 40-120 mL (50 +/- 37 mL) of 1:1,000,000 epinephrine (epinephrine group). In the remaining 92 patients, epinephrine irrigation was not performed (control group). Acute pancreatitis was defined by a serum amylase concentration fivefold greater than the upper limits of normal in association with abdominal pain. RESULTS: After EBS, serum amylase concentrations were significantly increased in both groups. However, the degree of hyperamylasemia was less in the epinephrine group than in the control group (617 +/- 611 vs 1037 +/- 1491 IU/L, P < 0.05). The incidence of pancreatitis was lower in the epinephrine group than in the control group (1.2 vs 7.6%, P < 0.05). CONCLUSIONS: Epinephrine irrigation is a simple and useful method to prevent post-EBS pancreatic damage and pancreatitis.     

Endoscopic balloon dilatation is a safe method in the management of common bile duct stones

BACKGROUNDS AND AIMS: Endoscopic sphincterotomy is a widely accepted treatment for patients with common bile duct stones. Despite improvement in this technique, endoscopic sphincterotomy is still associated with some biliary complications. Endoscopic balloon dilatation is a less traumatic and sphincter preserving method for removal of common bile duct stones. However, the results of controlled studies in comparison with these two methods are contradictory. The aim of this study is to compare the safety and efficacy of endoscopic balloon dilatation and endoscopic sphincterotomy in Chinese patients. PATIENTS AND METHODS: A total of 104 patients with common bile duct stones on endoscopic retrograde cholangiopancreatography were enrolled. They were randomly assigned to endoscopic balloon dilatation or endoscopic sphincterotomy. Endoscopic balloon dilatation was performed by using a balloon dilator to dilate the sphincter for 5 min. The common bile duct stones were then removed by a Dormia basket after endoscopic balloon dilatation or endoscopic sphincterotomy. Mechanical lithotripsy was performed if the stones were difficult to remove by Dormia basket. After discharge, patients were regularly followed up for biliary complications. RESULTS: The successful bile duct stone clearance rate was 94.1% in endoscopic balloon dilatation group and 100% in endoscopic sphincterotomy group. Post-procedural significant haemorrhage was higher in endoscopic sphincterotomy group than in endoscopic balloon dilatation group (14/53 versus 1/48, P < 0.001). The bleeding patient from endoscopic balloon dilatation group was a case of uremia and bleeding occurred 48 h after endoscopic balloon dilatation. All the patients with post-procedural haemorrhage were controlled endoscopically. The post-procedural serum amylase level showed no significant difference in both groups and none of them developed clinical pancreatitis. After a mean 16 months follow-up, three patients (6.3%) in endoscopic balloon dilatation group and four patients (7.5%) in endoscopic sphincterotomy group developed recurrent common bile duct stones. The recurrent common bile duct stones were multiple and muddy in consistency. They were successfully removed endoscopically. CONCLUSION: Both endoscopic balloon dilatation and endoscopic sphincterotomy are safe and effective techniques for the treatment of common bile duct stones. Endoscopic balloon dilatation can be safely applied in patients with coagulopathy and does not increase the incidence of pancreatitis or bleeding.     

Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones

BACKGROUND: Pancreatitis is the most serious complication of endoscopic sphincter dilation. The aim of this study was to determine whether temporary stent placement in the main pancreatic duct decreases the frequency of pancreatitis and level of hyperamylasemia. METHODS: Stents were placed in the pancreatic duct after endoscopic sphincter dilation in 40 consecutive patients with bile duct stones. Stents were removed endoscopically 3 days later. Changes in serum amylase and the frequency of pancreatitis for this group were compared with those in 92 patients who underwent sphincter dilation without pancreatic duct stent placement. RESULTS: Stent placement was successful in 38 of 40 patients. Although the difference in the frequency of pancreatitis was not significantly different between stent and control groups, there was a trend toward a decrease in pancreatitis in the stent group. The level of postprocedure hyperamylasemia was significantly less in the stent group (p < 0.05). There were no procedure-related complications. CONCLUSIONS: Temporary placement of a stent in the pancreatic duct after sphincter dilation for removal of bile duct stones has a beneficial effect in terms of postprocedure hyperamylasemia and appears to reduce the frequency of postprocedure pancreatitis.     

Predictors for choledocholitiasis in patients undergoing endoscopic ultrasound

Aim: Biliary lithiasis is common in most western countries. Symptomatic patients will also have choledocholithiasis in 10% of the cases. For patients with intermediate probability of CBD stones, the recommended imaging studies are endoscopic ultrasound (EUS) or MRCP. This study aims to identify early factors that can be used as predictors for the presence of CBD stones, and by that to find which patient should undergo ERCP without an early EUS.

Methods: This is a retrospective cohort study including all patients who underwent EUS for suspected choledocholithiasis at the Soroka University Medical Center (SUMC) in the years 2009–2014. Data collection was performed by manual surveillance of patients’ computerized files and data gathering after approval by the Soroka Institutional Review Board

Results: One hundred seventy-five (175) patients were included in the study. The average age was 57, and 111 patients were women (64.2%). Sixty-two patients (35%) had common bile duct stones by EUS and underwent an ERCP. Eighty-two percent of those 62 patients were found to have CBD stones at ERCP. Patients found positive for CBD stones by EUS were older than those who were negative (52 vs. 71 respectively, p?<?.001). These patients were also found to have a higher prevalence of ischemic heart disease and congestive heart failure. Common bile duct dilatation?≥8mm and gallstones presence in abdominal ultrasonography were more common in patients found positive for CBD stones by EUS than in those who were found negative (45% vs. 24% p?<?.05, and 81% vs. 66% p?<?.05, respectively). Alkaline phosphatase (ALP) serum levels higher than 300?IU/L were found to be the only independent predictor for the existence of CBD stones (OR = 2.98, p?=?.001(. When ALP serum levels lower than 150?IU/L or GGT lower than 150?IU/L were measured, the probability of having CBD stones was low (NPV of 90% and 87%, respectively).

Conclusions: ALP serum levels higher than 300?IU/L are an independent predictor for the presence of CBD stones. EUS is an excellent screening tool for choledocholithiasis before performing ERCP. In most patients who undergo an early EUS, a subsequent diagnostic ERCP will not be needed.     

Technique of laparoscopic cholecystectomy combined with percutaneous papillary balloon dilatation under general anesthesia for cholecystocholedocholithiasis

Since the introduction of laparoscopic cholecystectomy (LC), the treatment of cholecystocholedocholithiasis has become a controversial issue among surgeons and endoscopists all over the world. We evaluated the effectiveness of LC combined with percutaneous papillary balloon dilatation (PPBD) under general anesthesia in the treatment of cholecystocholedocholithiasis in 22 patients. All stones in the bile duct were successfully evacuated into the duodenum in all patients. The PPBD was feasible in all patients under general anesthesia. The mean postoperative stay was 9 days. The overall length hospital stay and the duration of PTBD were 19 ± 7 days and 16 ± 8 days, respectively. There were no deaths nor major complications, although a transient hyperamylasemia was found in 10 patients (45%). Cholecystocholedocholithiasis was able to be treated by means of LC combined with PPBD under general anesthesia without laparotomy, sphincterotomy or choledochotomy. This technique can be a choice for the treatment that enables a patient to avoid any discomfort arisen as a result of papillary dilatation.     

Whether or not prophylactic excision of the extrahepatic bile duct is appropriate for patients with pancreaticobiliary maljunction without bile duct dilatation

BACKGROUND/AIMS: The standard treatment for patients with a pancreaticobiliary maljunction (PBM) without bile duct dilatation remains controversial. METHODOLOGY: We followed up 29 patients with such PBM who mainly underwent a cholecystectomy alone. The ages of the patients ranged from 3 to 76 years (average age 47.3 years) and the ratio of males to females was 8 vs. 21. When the diameter of the common bile duct was less than 10mm, such bile ducts were diagnosed to have no dilatation. The main clinical indications for surgery were cholecystolithiasis in 15 patients, choledocholithiasis in 3, cholecystocholedocholithiasis in 2, gallbladder polyp in 2, adenomyomatosis in 2, cholecystitis in 2, and protein plug in 1. RESULTS: The amylase levels of gallbladder bile in 20 patients ranged from 115 to 460,200 IU/mL (a mean of 191,698 IU/mL). One patient died of gastric cancer 182 months after surgery and two patients died of other diseases 153, 171 months after surgeries, respectively. The remaining 26 patients have all been doing well for 36 months to 326 months after surgery (a median follow-up period, 160.5 months). The 10- and 15-year survival rates were 100% and 89.7%. CONCLUSIONS: In conclusion, a prophylactic resection of the extrahepatic bile duct and biliary diversion could be unnecessary for patients with PBM without bile duct dilatation.     

Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty

AIMTo investigate the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS).METHODSAfter bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group).RESULTSOne hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was - 25.0 (217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5 (576.3) IU/L observed in the control group (P < 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P < 0.001).CONCLUSIONPrior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS.     

Periampullary diverticula cause pancreatobiliary reflux

BACKGROUND: Periampullary diverticula are associated with dysfunction of the sphincter of Oddi. Papillary dysfunction may allow reflux of pancreatic juice as well as intestinal contents into the common bile duct. We prospectively investigated pancreatobiliary reflux in patients with and without periampullary diverticula. METHODS: The ductal bile was sampled for amylase concentration during endoscopic retrograde cholangiopancreatography in 47 patients with choledocholithiasis (n = 29; with (n = 14) or without (n = 15) periampullary diverticula) or gallbladder cholesterol polyps (n = 18; with (n = 6) or without (n = 12) diverticula). RESULTS: The amylase concentration within the ductal bile was significantly higher in choledocholithiasis patients with periampullary diverticula (1621 +/- 587 IU/l) than in those without diverticula (1155 +/- 418 IU/l). The amylase concentration tended to be higher in gallbladder polyp patients with diverticula (1087 +/- 275 IU/l) than in those without diverticula (833 +/- 272 IU/l). Irrespective of the presence or absence of diverticula, patients with bile duct stones had significantly higher amylase concentrations than those with gallbladder polyps. CONCLUSIONS: Periampullary diverticula cause pancreatobiliary reflux. Further investigation is required to determine the clinical implication of pancreatobiliary reflux.     

Endoscopic papillary balloon dilation for treatment of common bile duct stones

BACKGROUND/AIMS: Use of endoscopic papillary balloon dilation (EPBD) for the treatment of common bile duct stones has increased in recent years, owing to its simplicity and its advantage of preserving sphincter function. It has been reported that EPBD is associated with a lower risk of bleeding, but a higher risk of pancreatitis than endoscopic sphincterotomy. However, there have been few reports on studies of post-EPBD pancreatitis. This report concerns the use of EPBD at our department for the treatment of common bile duct stones and early postoperative complications, with a focus on pancreatitis. METHODOLOGY: The study was conducted in 63 patients with choledocholithiasis, including 4 patients with cirrhosis and 21 patients with periampullary diverticula. The stones were extracted after EPBD conducted with an 8-mm dilatation balloon. RESULTS: Complete removal of stones was achieved in 53 out of 63 patients (84.1%). Pancreatitis meeting the criteria of Cotton et al. occurred in 7 of the 63 patients (11.1%), while 12 patients (19.5%) were affected when milder cases of pancreatitis were included. Severe pancreatitis occurred in 1 patient only. Cholangitis occurred in 3 patients (4.8%) and basket impaction occurred in 1 patient (1.6%), but no serious complications such as bleeding or perforation were encountered. CONCLUSIONS: These results suggest that EPBD is an effective procedure for the treatment of common bile duct stones, with a low risk of serious complications.     

Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation

BACKGROUND: Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed. METHODS: In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated. A multivariate analysis was conducted for 20 potential risk factors related to clinical and procedure characteristics. RESULTS: Bile duct clearance was achieved in 113 patients. Early complications in the form of mild pancreatitis occurred in 7 patients (6%). Multivariate analysis identified history of acute pancreatitis as the only risk factor for postendoscopic papillary balloon dilation pancreatitis. Postendoscopic papillary balloon dilation hyperamylasemia occurred in 30 patients (25%). Multivariate analysis identified 4 independent risk factors for hyperamylasemia: an age of 60 years or less, previous pancreatitis, bile duct diameter 9 mm or less, and difficult bile duct cannulation. CONCLUSIONS: Endoscopic papillary balloon dilation is associated with a relatively low occurrence (6%) of pancreatitis but a high frequency (25%) of hyperamylasemia. The latter may represent pancreatic irritation or latent pancreatic injury. Particular care is necessary when endoscopic papillary balloon dilation is performed in younger patients, those with a history of pancreatitis, patients with a nondilated bile duct, and when cannulation is difficult.     

内镜逆行胰胆管造影十二指肠乳头括约肌切开取石诊治胆总管结石163例体会

目的探讨内镜逆行胰胆管造影（ERCP）十二指肠乳头括约肌切开（EST）诊断、治疗胆总管结石的临床效果和价值。方法163例临床诊断胆总管结石者行ERCP检查，造影成功159例，150例确诊为胆总管结石并经内镜行乳头括约肌切开术。结果胆总管结石ERCP与临床诊断符合率为94．3％；胆总管结石150例，取石成功141例，成功率94．0％；EST术后发生急性胰腺炎4例，少到中等量肠道出血3例，高淀粉酶血症5例，无肠穿孔、大出血及死亡等并发症发生。结论ERCP可提高胆管结石的诊断准确率；EST取石是肝外胆管结石治疗的优良方法，对已作胆囊切除后肝外胆管残留或复发结石并应为首选治疗方法。     

Value of ultrasound and liver function tests in determining the need for endoscopic retrograde cholangiopancreatography in unexplained abdominal pain.

The value of serum liver function tests and abdominal ultrasound as screening tests of the need for endoscopic retrograde cholangiopancreatography (ERCP) was determined in patients with unexplained abdominal pain without associated jaundice. In 1989 and 1990 1005 ERCPs were undertaken, of which 138 (14%) were for this indication. The duct or ducts of interest were delineated by ERCP in 95% of patients. The lesions found were bile duct stones in 10 patients, chronic pancreatitis in five, pancreatic carcinoma in one, peptic ulcer or duodenitis in four. A satisfactory ultrasound examination had been performed in 94% of patients. For chronic pancreatitis, its sensitivity was 60% and specificity 95%. For choledocholithiasis, the ultrasonic detection of duct dilatation or stones had a sensitivity of 90% and specificity of 86%. Of the liver function tests, the alkaline phosphatase was more sensitive (67%) than the transaminases (44%) in indicating the presence of bile duct stones and had a high specificity (95%). None of the 10 patients with duct stones had normal ultrasound and normal alkaline phosphatase. Thus it was found that demonstration of a normal common bile duct by abdominal ultrasound and normal serum alkaline phosphatase together have 100% specificity in excluding bile duct stones. Using such knowledge over the two year period of this study would have spared 36 patients the need for ERCP.     

Are duodenal diverticula associated with choledocholithiasis?

The results of 250 consecutive ERCP examinations were analysed in order to assess whether or not juxtapapillary duodenal diverticula are associated with choledocholithiasis. Cholangiography showed common bile duct stones in 71 patients of whom 25 (35%) had periampullary diverticula. Clear bile ducts were shown in 99, of whom only 12 had diverticula (12%) (p less than 0.05). After allowing for the differences in age between the two groups, patients with choledocholithiasis were 2.6 times (95% CI: 1.14-5.93) more likely to have a periampullary diverticulum than patients without choledocholithiasis. In the remaining 80 patients, cholangiography was either not successful or not indicated. Further clinical follow up and/or investigation have failed to reveal duct stones in any and only 10 (13%) of these 80 patients had diverticula. Overall, 47 patients had diverticula: 25 (53%) had duct stones, four may have had stones and 18 had none. Three or more years after cholecystectomy 59% of patients with duct stones had diverticula, while only 13% with clear ducts had them. These results show a significant association between periampullary duodenal diverticula and choledocholithiasis.     

ENDOSCOPIC SPHINCTEROTOMY OF THE PAPILLA OF VATER: AN ANALYSIS OF 300 CASES

Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978–1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p<0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high-risk patients with choledocholithiasis without cholecystectomy.     

Hyperamylasaemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography

Hyperamylasaemia and acute pancreatitis are the more common complications of endoscopic retrograde cholangiopancreatography (ERCP). Ninety patients who underwent ERCP +/- endoscopic papillotomy were monitored for rises in the serum amylase and the development of acute pancreatitis. The incidence of hyperamylasaemia (greater than 300 IU/L) was significantly greater (p = 0.01) when the pancreatic duct was imaged (75%) than with bile duct imaging alone (33%). The incidence of acute pancreatitis following imaging of the pancreatic duct +/- bile duct was 11.3% and was found to be significantly increased in those patients (n = 9) who also underwent endoscopic papillotomy. Imaging of the biliary tree only +/- endoscopic papillotomy carried no significant risk of acute pancreatitis. In those patients who developed pancreatitis, the rise in serum amylase occurred early and was significantly higher at 2 h following ERCP. These findings may help to identify patients who are at risk of developing this complication.     

生长抑素及ENBD对预防ERCP术后胰腺炎的临床对照

目的:探讨预防性应用生长抑素及术后放置鼻胆引流管对经内镜胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)后胰腺炎及高淀粉酶血症的作用及安全性.方法:按照既定标准入院接受ERCP诊治的患者110例,随机分为3组,分别给予生长抑素组、ENBD及安慰剂.观察术后胰腺炎、高淀粉酶血症的发生情况、预后及经济学评价.结果:3组患者中术后胰腺炎总发生率为17.2%(n=19),高淀粉酶血症为4.54%(n=5),对照组胰腺炎、高淀粉酶血症发生率明显高于其余2组(P<0.05);血清淀粉酶变化,生长抑素组(467IU/L±63IU/L)、ENBD组(501IU/L±405IU/L)术后6h较对照组(1323IU/L±46IU/L)低,差距有统计学意义(P<0.05);但术后24h血清淀粉酶水平无显著性差异(P>0.05);生长抑素组及ENBD组胰腺炎患者腹部症状体征消失时间、血象下降时间、平均住院时间均较对照组明显缩短,差距有统计学意义(P<0.05);对比2种预防ERCP术后胰腺炎的方法,生长抑素费用明显低于ENBD,可大大降低医疗费用的支出,差距有统计学意义(P<0.05).结论:生长抑素、鼻胆引流管均可有效预防ERCP术后胰腺炎及高淀粉酶血症的发生,生长抑素更为经济.     

Safeguards against acute pancreatitis associated with endoscopic papillary balloon dilatation

Background/Purpose

Endoscopic papillary balloon dilatation (EPBD) is one of the methods used to remove bile duct stones. EPBD may preserve the function of the sphincter of Oddi in spite of the potential risk of acute pancreatitis caused by the procedure. There are only few reports of attempts to reduce the risk of acute pancreatitis in EPBD.

Methods

We performed EPBD for bile duct stone removal in 201 patients. We used an 8-mm balloon followed by drip infusion of isosorbide dinitrate (ISDN) at a rate of 5?mg/h for low-pressure EPBD. The function of the minor duodenal papilla, the inflation pressure required for the disappearance of the notch sign in the bile duct, and the serum amylase level after EPBD were observed.

Results

The median serum amylase level after the procedure was 367?IU/l. Acute pancreatitis occurred in two patients (1.0%). The two patients with acute pancreatitis had poor function of the minor duodenal papilla, a high inflation pressure (over 5?atm) required for disappearance of the notch, sign, and severe abdominal pain during balloon inflation; as well, the procedure took a long time. The rate of duct clearance was 99.5%.

Conclusions

EPBD with gradual inflation of the balloon at a low pressure, followed by ISDN drip infusion, could decrease the risk of acute pancreatitis associated with the procedure. Poor function of the minor duodenal papilla, high inflation pressure required for disappearance of the notch, sign, severe abdominal pain, and a lengthy procedure increase the risk of acute pancreatitis after EPBD.     

EST术联合EPBD术治疗非扩张性肝外胆管结石患者临床研究*

目的 探讨采用十二指肠镜下乳头括约肌切开（EST）联合十二指肠镜下乳头气囊扩张（EPBD）术治疗非扩张性肝外胆管结石患者的临床效果。方法 回顾性分析我院诊治的124例非扩张性肝外胆管结石患者的临床资料,联合组采用EST术联合EPBD术（n=49）、观察组采用单纯EST术（n=31）和对照组采用胆总管切开T管引流术（n=44）治疗。结果 术后48 h时,联合组血清淀粉酶水平为（107.1±34.6） U/L,超敏C-反应蛋白水平为（37.2±8.9） mg/L,观察组分别为（113.9±35.2） U/L和（38.1±9.4） mg/L,均显著低于对照组[分别为（221.5±54.8） U/L和（73.2±16.2） mg/L,P<0.05];联合组手术时间为（95.2±14.8） min,观察组为（113.6±12.7） min,均显著长于对照组[（84.8±12.1）,P<0.05];联合组胰腺炎和反流性胆管炎发生率分别为2.0%和4.1%,显著低于观察组的19.4%和22.6%或对照组的18.2%和22.7%（P<0.05）。结论 采用EST联合EPBD术治疗非扩张性肝外胆管结石患者操作易行,效果好,术后恢复快,近远期并发症发生率低,有较高的临床应用价值。