内镜下胆道支架引流术治疗难治性胆总管结石

目的观察内镜下胆道支架引流术(ERBD)治疗难治性胆总管结石的疗效。方法对9例反复腹痛、发热、黄疸、结石最大直径20mm以上、伴基础疾病或因乳头胆管解剖因素行EST或高风险手术的难治性胆总管结石病例行ERBD,并随访6～18个月。结果9例完成ERCP+ERBD,术后1周内腹痛发热消失,黄疸明显减轻。随访观察6例未再发生腹痛、发热、黄疸,3例偶尔出现畏寒发热,B超复查9例肝内外胆管扩张明显回缩,8例胆总管结石有不同程度缩小,1例结石大小无变化。结论ERBD治疗胆总管结石具有溶石碎石作用,对高龄、伴基础疾病、难治性胆总管结石行ERBD是明智的选择。

Treatment for intractable choledocholithiasis by endoscopic retrograde biliary stent placement drainage

[Objective] To observe the curative effect of the treatment for intractable choledocholithiasis by endoscopic retrograde biliary stent placement drainage(ERBD). [Method] ERBD was finished in 9 patients with intractable choledocholithiasis who appear abdominal pain and fever and jaundice again and again. At the same time, the patients existed fundamental diseases or were given to endoscopic sphincterotomy(EST) or had high risk for operation and they were followed up from 6 to 18 months. [Results] Endoscopic retrograde cholangiopancreatography (ERCP) and ERBD were finished for all patients, and abdominal pain or fever vanished and jaundice went down significiantly. Six of them did not appear abdominal pain or fever or jaundice again, and three of them feared cold and had fever now and then. Cholangiectasis syndromes in both intrahepatic bile duct and extrahepatic bile duct got retracted. Common duct stones shrinked in 8 patients in different degrees and calculus had no change in 1 patient by B type ultrasonic wave check. [Conclusion] ERBD takes effects in soluting and comminuting calculus in treating choledocholithiasis, and it is a judicious choice to the eld or the patients along with basic diseases or intractable choledocholithiasis.