ERCP及EST治疗胆总管结石375例临床分析

目的 总结应用逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）和内镜插约肌切开取石术（endoseopie sphineterotomy，EST）治疗胆总管结石的疗效.方法 肌管结石患者375例，常规行ERCP检查，证实胆管内有结石后行EST，然后根据结石部位、大小和数目以及肌总管直径大小采取不同方法处理结石：①结石直径小于1．0cm的291例予取石网篮取石；②结石直径大于1．0cm的69例予碎石篮碎石；③结石与胆总管直径大小相当和／（或）胆总管下段狭窄且结石坚硬的5例予应急碎石器碎石后再取石；④6例结石巨大和（／或）肌总管内多发结石，取石或碎石篮不能套住而于胆管内置支架1～3月．待再次手术处理。另4例无法取石者仅行ERCP。结果 本组患者中EST成功366例（97．6％），胆总管结石完全取出360例（96．0％）：发生各种并发症13例（3．5％），主要为急性胰腺炎、急性胆管炎和Oddi扩约肌切口渗血，未成功病例及1例并发急性重症胰腺炎中转开腹手术治疗治愈．其余均非手术治疗治愈，无死亡病例。结论 ERCP和EST诊治胆管结石特别是胆总管结石，安全、有效，病人痛苦小。

Treatment of Choledocholithiasis by ERCP and EST (with a Report of 375 Cases)

Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST) for choledocholithiasis. Methods 375 cases underwent ERCP to make the diagnosis of choledocholithiasis and the subsequent EST to remove the stones. The stones removed via varied approaches depending on the different situation in terms of site, diameter and number of stones and diameter of common bile duct, including lithobasket removing in 291 cases with stones less than 1 cm in diameter, lithoclast in 69 cases with more than 1 cm in diameter, combination of lithobasket and lithoclast in 5 cases with common bile ductal sized stones and bile ductal distal end stenosis, intraductal internal stent placement for 1 to 3 months in 6 cases with giant or multiple stones and failed to be removed by lithobasket or lithoclast. The rest 4 cases only received ERCP. Results EST was successfully performed in 366 cases, complete removal of stones achieved in 360 cases. Complications occurred in 13 cases including acute pancreatitis, acute cholangitis and staxis of Oddi's sphincter incision. Failed cases and 1 case of severe acute pancreatitis underwent laparotomy and cured. There was no death. Conclusion Combination of ERCP and EST is safe, effective and less pain for choledocholithiasis.