经内镜乳头肌切开并塑料支架放置分期治疗巨大胆管结石

目的探讨I期应用十二指肠镜行乳头肌切开并塑料支架放置，Ⅱ期再经内镜取出结石治疗巨大胆管结石的价值。方法21例巨大胆总管结石患者，应用电子十二指肠镜先常规行ERCP及乳头肌切开，在短时间内应用取石网篮难于成功的情况下，行胆总管内塑料支架放置先解除梗阻，定期随访期间择期再行支架去除及结石取出。结果19例巨大胆总管结石患者按期随访通过分期的方法均成功取出结石，均未出现操作相关并发症。有2例患者分别在首次ERCP后11个月和14个月因支架阻塞并阻塞性黄疸和急性胆管炎再次住院。经十二指肠镜取出支架和结石，亦未出现操作相关并发症。结论经内镜乳头肌切开并塑料支架放置分期治疗巨大胆管结石安全、有效、并发症少。

Stage-wise treatment of large common bile duct stones through endoscopic sphincterotomy and plastic biliary stenting

Objective To investigate the effect of stage-wise treatment with endoscopic sphincterotomy and plastic bil- iary stenting on large common bile duct stones. Methods Twenty-one patients with large common bile duct stones were first treated through endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, when stone removal couldn＇t achieve within relatively short time, plastic stent was placed to relief obstruction. Stent and stone re- moval treatment were further carried out during the follow-up periods. Results Stones were successfully removed through stage-wise treatment in 19 patients who completed regular follow-up. Two patients were hospitalized develop- ing obstructive jaundice and acute cholangitis after 11 and 14 months, respectively, both stents and stones were suc- cessfully removed through duodenoscope, no complication has been found. Conclusion Stage-wise treatment of large common bile duct stones through endoscopic sphincterotomy and plastic biliary stenting is an effective and safe method with few complications.