内镜下十二指肠乳头气囊扩张术治疗胆管结石的临床研究

目的　探讨应用十二指肠乳头气囊扩张术 (EPBD)后进行胆管结石内镜治疗的有效性和安全性。方法　实施EPBD 42例 ,应用气囊将十二指肠乳头开口扩张至 8mm ,直接用取石网篮取石 ,当结石较大时先行机械碎石网碎石后再取石。术后鼻胆管引流 ,并造影复查。结果　 41例成功完成EPBD ,3 8例单次内镜治疗清除结石 ,3例行两次十二指肠镜下取石治疗 ,其中 1例再次内镜治疗时改为十二指肠乳头括约肌切开术 (EST)后取石。 9例附加机械碎石术。 41例中无出血、穿孔、重症胆管炎或重症胰腺炎发生 ,无术后胆管明显积气 ;10例出现高淀粉酶血症 ,72h内恢复。结论　EPBD后取石具有与EST后取石相近的成功率 ,出血风险低 ,胰腺炎发生率并不高 ,机械碎石比例较EST术后为高。主要适用于直径小于 10mm的肝外胆管结石 ,但对较大结石也可应用。

Endoscopic pappillary balloon dilation in endoscopic management of bile duct stones

Objective To evaluate the efficacy and safety of endoscopic papillary balloon dilation(EPBD)in the endoscopic management of bile duct stones.Methods A total of 42 patients with extrahepatic bile duct stones were treated edoscopically after EPBD.The papilla orifice was dilated to 8 mm,and then the stones were extracted immediately or after mechanical lithotripsy.Results EPBD was successful in 41 patients,and stones in all of them were completely removed.Mechanical lithotripsy was applied in 9 of them.Three patients took 2 ERCP sessions respectively and another one received endoscopic sphincterotomy.There was no massive hemorrhage,perforation,severe cholangitis or pancreatitis.All 10 cases of hyperamylasemia were recovered soon in 72 h.No obvious biliary emphysema was found 1 month after EPBD.Conclusions Comparing with EST,EPBD results in a similarly successful endoscopic clearance of extrahepatic bile duct stones,a low hemorrhagic risk and a higher requirement of lithotripsy.The severe pancreatitis complication after EPBD was not significantly higher in our study than that after EST.EPBD is suitable for patients with extrahepatic bile duct stones smaller than 10 mm,and also useful in case of larger stones.