内镜下乳头切开术治疗胆管结石的疗效分析692例

目的探讨内镜下十二指肠乳头括约肌切开术(EST)治疗胆管结石的疗效。方法收集保山市人民医院1999年1月至2009年2月间行EST治疗胆管结石的748例患者的临床病例资料,对其中资料完整的692例患者进行回顾性分析。结果出现近期并发症(≤术后3个月)者112例,发生率为16.81%。其中EST手术因各种原因失败23例,穿孔6例全部手术处理,1例因感染合并多器官功能衰竭死亡;出血11例,其中9例镜下止血,1例手术止血后死于十二指肠瘘并多器官功能衰竭;急性胰腺炎72例,其中因合并肺部感染、多型性药疹、肾功能衰竭死亡3例。远期(>术后3个月)并发症者129例,发生率为18.64%。其中,胆总管结石复发者96例;单纯反流性胆管炎9例;胆管结石残留8例;结石性胆囊炎10例;慢性胰腺炎6例。结论 EST术治疗胆管结石疗效肯定,但应注意严格选择适应证。

Retrospective Analysis of Curative Effect of Endoscopic Sphincterotomy in the Therapy of Cholangiolithiasis: 692 Cases Report

Objective To investigate the curative effect of endoscopic sphincterotomy（EST） in the therapy of cholangiolithiasis.Methods To assemble the clinical date of 748 cases with cholangiolithiasis which underwent EST surgery from January 1999 to February 2009 in Baoshan people＇s hospital,and 692 complete data were retrospectively analyzed.Results 112 cases were in a short-term complications（≤3 months after operation）,incidence rate was 16.81%,of which EST surgery failed for various reasons in 23 cases,perforation in 6 cases,all for surgical treatment,one cases died of infection combined with multiple organ failure;hemorrhage in 11 cases,of which nine cases were treated with endoscopic hemostasis,1 patient died of Duodenal fistula combined with multiple organ failure afer endoscopic hemostasis;acute pancreatitis in 72 cases,of which 3 cases died of pulmonary infection,polymorphic eruption,renal failure.129 cases were in Long-term（3 months after operation） complications,incidence rate was 18.64%.Among them,cholangiolithiasis recurrence in 96 cases;simple reflux cholangitis in 9 cases;bile duct stones residual in 8 cases;calculous cholecystitis in 10 cases;chronic pancreatitis in 6 cases.Conclusion The efficacy of EST in the surgical treatment of cholangiolithiasis is positive,but the selection of indications should be treated seriously.