经十二指肠镜括约肌切开胆总管结石的处理(附168例报告)

目的：采用各种方法处理不同大小的胆总管结石。方法：于1986年3月至1996年9月经内镜括约肌切开（EST）治疗胆总管结石168例，其中单颗结石63例，2颗结石56例，3颗以上结石49例，最多一例8颗结石，结石的直径为5～25mm不等。结果：165例（98．2％）切开成功，3例失败。161例（95．8％）结石排出，其中96例（59．6％）结石自然排入肠道，57例（35．4％）采用网篮或气囊取出结石，6例（3．7％）采用碎石网篮碎石后排出，2例（1．2％）经震波碎石后排出。术后出现胃肠道出血1例（0．6％），胰腺炎1例（0．6％），胆管炎3例（1．8％）。48例术后行胃肠钡餐检查，43例胆道内无钡剂返流，2例胆道内有积气，3例有钡剂返流入胆道，但无临床症状。结论：EST是目前治疗胆管结石的重要手段之一。

Treatment of common bile duct stone by endoscopic sphincterotomy

Objectives:To discuss treatment of common bile duct stone by various methods.Methods:168 patients with common bile duct stone were treated with EST (endoscopicsphincterotomy) in Zhongshan Hospital from March 1986 to Sept. 1996. The number of calculi foundin the patient varied from 1 to 8, among these, 63 cases with single stone only, 56 had two calculi,the remaining had more thantwo. The diameter of the calculi varied from 5~25mm. Results:TheEST procedure was successful in 165 cases (98.2%) and failed in three only. These were eliminatedin 161 patients (95.8%), among them, 59.6% were expelled into the intestinal tract, 35.4% wereextracted through the basket or by way of balloon, 3.7% were expelled after mechanical lithotripsyand 1.2% after extra corporal shock wave. After the procedure 2 cases had gastrointestinalhemorrhage(1.2%), 2 had pancreatitis (1.2%) and 3 had cholangitis (1.9%). Barium meal study wasthen carried out in 36 cases, 2 cases were found to have air in the common bile duct, 2 had reflux ofbarium into the biliary tract, but were asymptomatic. Conclusions:EST remains one of the mostimportant methods in treating common bile duct stone.