内镜逆行胰胆管造影十二指肠乳头括约肌切开取石诊治胆总管结石163例体会

目的探讨内镜逆行胰胆管造影（ERCP）十二指肠乳头括约肌切开（EST）诊断、治疗胆总管结石的临床效果和价值。方法163例临床诊断胆总管结石者行ERCP检查，造影成功159例，150例确诊为胆总管结石并经内镜行乳头括约肌切开术。结果胆总管结石ERCP与临床诊断符合率为94．3％；胆总管结石150例，取石成功141例，成功率94．0％；EST术后发生急性胰腺炎4例，少到中等量肠道出血3例，高淀粉酶血症5例，无肠穿孔、大出血及死亡等并发症发生。结论ERCP可提高胆管结石的诊断准确率；EST取石是肝外胆管结石治疗的优良方法，对已作胆囊切除后肝外胆管残留或复发结石并应为首选治疗方法。

Experience of diagnosis and treatment of 163 cases with Choledocholithiasis by endoscopic retro-grade cholangiopancreatography and endoscopic sphincterotomy

Objective To investigate the clinical effect and value of the endoscopic retrograde cholangiopancreatography （ERCP） and endoscopic sphincterotomy （EST） to diagnosis and treatment of Choledocholithiasis. Methods One hundred and sixty-three cases diagnosed as choledocholithiasis were performed by ERCP. One hundred and fiftynine cases were performed by ERCP successfully. One hundred and fifty cases were diagnosed as choledocholithiasis by ERCP and performed by EST. Results One hundred and fifty cases were diagnosed as choledocholithiasis by ERCP. The accordance rate was 94.3% ; 141 cases were performed by EST successfully. The success rate was 94.0%. The complications after EST included 4 patients with acute pancreatitis, 3 patients with intestinal bleeding, 5 patients with hyperamylasemia. The complications including intestinal perforation, haemorrhage or death never occured. Conclusion ERCP can increase the diagnosis accuracy rate of Choledocholithiasis. Removing extrahepatic bile duct stones by ERCP and EST is an excellent method of treatment, and should prefer as a treatment for the patients with ex.trahepatic bile duct stones residual or recurrent after Cholecystectomy.