乳头括约肌小切开联合气囊扩张术对不规则乳头的胆总管结石患者的疗效观察

目的 观察乳头括约肌小切开联合气囊扩张术对不规则乳头(合并憩室50例、手术后43例、无明确病因的肠腔走行异常10例)的胆总管结石(CDS)患者的疗效.方法 2007年7月至2010年3月103例不规则乳头的CDS患者随机分为3组,3组间一般情况无显著性差异(P＞0.05).34例行乳头括约肌切开术(EST组)；34例行乳头气囊扩张术(EBD组);35例行乳头括约肌小切开联合气囊扩张术(EST+ EBD组).均根据实际情况在乳头治疗后行取石网篮和(或)气囊取石,部分患者以碎石网篮碎石后取石,少数巨大结石无法一次性取石仅放置塑料支架.结果 96例ERCP成功；EST小切开联合EBD与单纯EST比较,虽然一次性取石成功率无明显差异,但却显著降低了术后并发症的发生率,尤其是出血发生率(P＜0.05)；较单纯EBD,则显著提高了一次性取石成功率(P＜0.05),减少了碎石网篮使用率,且明显降低了术后急性胰腺炎的发生率(P＜0.05).结论 不规则乳头的胆总管结石患者ERCP成功率仍较高；EST小切开联合EBD对不规则乳头CDS患者维持了较高的一次性取石成功率,减少了术中、术后的并发症.

Treatment of common duct stones in patients with atypical papillae using small endoscopic sphincterotomy and endoscopic balloon dilatation

Objective To evaluate the effect of small endoscopic sphincterotomy and endoscopic balloon dilatation in the treatment of common duct stones (CDS) in patients with atypical papillae (combined with diverticula; after surgical operation; combined with abnormal duodenal lumen with no definite cause).Methods One hundred and three patients with CDS and with atypical papillae treated from July 2007 to March 2010 were randomly divided into three groups.Thirty-four patients received endoscopic sphincterotomy (EST group),34 patients received endoscopic balloon dilatation (EBD group) and the remaining 35 patients received small endoscopic sphincterotomy and endoscopic balloon dilatation (EST+EBD group).The general state of the patients in the 3 groups showed no significant difference (P＞0.05).We tried to remove all CDS using baskets and/or balloons after the procedures on the papillae.In some patients the stones were crushed by using a basket mechanical lithotriptor (BML).In some patients with huge stones,we could only placed in a plastic stent because of the high risk of removing the stones in a single procedure.Results Successful endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 96 patients.Patients in the EST+ EBD group had less complications,especially hemorrhage,when compared with the EST group (P＜0.05).Also,the EST+EBD group had a significantly higher success rate of complete stone removal (P＜0.05),decreased use of BML (P＜0.05) and decreased rate of acute pancreatitis when compared with the EBD group (P＜0.05).Conclusions The success rate of ERCP in managing patients with CDS with atypical papillae remained high.Small endoscopic sphincterotomy and endoscopic balloon dilatation had a higher success rate of removing stones at the first attempt and a decreased rate of complications.