内镜下十二指肠乳头球囊扩张联合切开术在肝外胆管结石治疗作用的探讨

目的探讨内镜下十二指肠乳头球囊扩张术（endoscopic papillary balloon dilation,EPBD）联合十二指肠乳头切开术（endoscopic sphincterotomy,EST）在肝外胆管结石治疗中的安全性及疗效。方法实施EST＋EPBD78例,所有病例最大结石直径均大于1.0cm（其中憩室旁乳头14例,憩室内乳头12例,余52例）,52例直径小于1.5cm结石均一次性取石成功;直径大于1.5cm结石经碎石网篮碎石后13例一次性取石成功,余13例经再次取石后清除全部结石。结果78例病例全部取石成功,3例出现高淀粉酶血症,2例出现轻症急性胰腺炎,无出血、穿孔等其他并发症。结论EPBD联合EST取石安全、有效,尤其对于结石大、乳头条件差的患者可提高取石成功率,减少并发症的发生。

Effect of endoscopic papillary balloon dilation and endoscopic sphincterotomy in treatment for extrahepatic bile duct stones

Objective To discuss the safety and efficacy of EPBD and EST in the treatment for extrahepatic bile duct stones.Methods 78 cases were performed by EST and ERBD,the maximum diameter of stones was 1.0cm in all cases（14 cases were periampullary duodenal diverticula,12 cases were in the diverticula of duodenum,52 cases are others）.All cases,diameter of stones less than 1.5cm,were performed one-time successfully;Diameter of stones more than 1.5cm,13 cases were performed one-time successfully after basket stone taken by endoscopic basket lithertrpay,others were cleared after performed again.Results 78 cases were stone-taken completely.After EST and EPBD included 3 cases with hyperamylasemia,2 cases with acut pancreatitis.The complacations including intestinal perforation,haemorrhage or death never occurred.Conclusion EPBD and EST is a safe and effective method for removing extrahepatic bile duct stones,especially in the treatment for the patients with large stones or poor duodenal papilla,which can increase the complete stone clearance rate and reduce the complication rate.