ERCP诊治胆总管结石128例临床分析

目的探讨经内镜逆行胰胆管造影（ERCP）及其相关技术在治疗胆总管结石中的作用。方法对128例胆总管结石患者行ERCP检查和治疗,主要包括内镜下乳头括约肌切开（EST）后网篮取石、网篮机械碎石后网篮或/和球囊取出结石碎片、球囊取石并球囊清理胆道;内镜下鼻胆管引流（ENBD）或塑料支架置入引流等治疗。对诊断和治疗情况及并发症进行回顾性总结分析。结果 128例患者ERCP检查发现结石显影120例,敏感性为93.8%,较腹部超声（BUS）检出率（80.5%）明显增高（P〈0.05）。插管成功率96.1%,一次性取石干净89例;68例次行EST后取石网篮取石,26例行网篮碎石后取石,22例行EST后取石球囊取石,7例先行ENBD后择期取石。取石后行ENBD 14例次,行塑料支架植入引流术2例。平均住院（5.8±1.1）d,术后患者腹痛症状消失,经复查结石均取尽。ERCP患者术后出现并发症19例（15.4%）,其中并发高淀粉酶血症14例,并发急性胰腺炎2例,电解质紊乱2例,消化道出血1例,均经内科保守疗法治愈。随访发现结石复发1例,未发现死亡病例。结论 ERCP及其相关技术是胆总管结石安全、微创、经济的治疗方法。

Clinical analysis of diagnosis and treatment of calculus of common bile duct by ERCP in 128 patients

Objective To explore the effects of endoscopic retrograde cholangiopancreatography(ERCP)and related techniques on calculus of common bile duct.Methods 128 patients with calculus of common bile duct were examined and treated by ERCP.The treatment included removing of calculus by basket after endoscopic sphincterotomy(EST),removing of calculus gallet by basket or sacculus proprius after basket mechanical lithotripsy,removing of calculus by sacculus proprius plus biliary tract cleaning by sacculus proprius and endoscopic nasobiliary drainage(ENBD)or drainage by insertion of plastic bracket.The situations of diagnosis and treatment and the complications were retrospectively summarized analyzed.Results Among the 128 patients,visualization of calculus were found in 120 ones by the ERCP examination.The sensitivity was 93.8%,which was significantly higher than that examined by belly ultrasound(BUS)(80.5%)(P<0.05).The achievement ratio of intubation was 96.1%,and the calculi in 89 patients were removed thoroughly at one time.The calculi in 68 cases were removed by basket after EST;those in 26 cases were removed by basket after lithotripsy;those in 22 cases were removed by sacculus proprius after EST;those in 7 cases were removed at a selective time after ENBD.Fourteen cases received ENBD after the removing of calculi.Two ones received the drainage by insertion of plastic bracket.The average hospital days were(5.8±1.1)d.Stomachache disappeared after the operation,and the reexamination showed all calculi were removed.Complications occurred in 19 cases receiving ERCP(15.4%).Among those,complicated hyperamylasemia occurred in 14 cases;complicated acute pancreatitis occurred in 2 cases;electrolyte disturbance occurred in 2 cases;alimentary tract hemorrhage occurred in 1 case.All these complications were cured by conventional expectant treatment.During the follow-up period,1 patient was found recurrence of calculus and no died case was found.Conclusion ERCP and its related techniques are safe,minimally-invasive and economical methods for calculus of common bile duct.