摘要
目的 探讨经内镜括约肌切开术 (EST)和内镜乳头气囊扩张术 (EPBD)治疗胆总管残留和复发性结石的应用价值。方法 经EST和EPBD共治疗胆总管结石 36 8例 ,其中胆囊切除术后残留结石 2 0 5例 ,胆道术后复发性结石 16 3例。对于 <10mm结石采用EPBD治疗 ,>11mm采用EST治疗。结果 36 2例 (98 4% )治疗成功。其中 46例经内镜治疗后结石自然排出 ,2 83例采用网篮或取石球囊取出结石 ,2 8例采用碎石网篮碎石后取出 ,5例经震波碎石后排出。 2 8例经 2～ 3次再次取石后取净。总的并发症发生率 3 0 % ,其中上消化道出血 1例 ,胆管炎 4例 ,胰腺炎 6例。 12 4例术后行胃肠X线钡剂检查 ,118例胆管内无返流 ,2例胆道内有积气 ,4例有钡剂入胆道。结论 EST和EPBD治疗胆道结石具安全、有效、并发症少 ,是目前治疗胆总管残留或复发性结石的重要手段。
Objective To evaluate endoscopic sphincterotomy (EST) and papillary balloon dilatation(EPBD) in treating residual or recurrent gallstones.Methods 368 patients with choledocholithiasis were given EST or EPBD,including residual gallstones in 205 cases,recurrent gallstones in 163 cases.Those cases with gallstones less than 10mm were given EPBD and those larger than 11mm were given EST treatments.Results The treatments of EST and EPBD succeeded in 362 cases(98.4%) and failed in 6 cases(1.6%).After endoscopic therapy,the gallstones in 46 cases were excluded naturally,238 cases were given basketball or balloon to get rid of the stones,28 cases were discharged with basketball lithotripsy,5 cases received extracorporeal shock-wave lithotripsy(ESWL).The choledocholithiasis in 28 of 362 cases were thoroughly cured after being treated for 2～3 times.Total complications were noted in 3.0% of these cases.Hemorrhage of upper gastrointestinal tract occurred in 1 case,cholangitis in 4 cases and pancreatitis in 6 cases.124 cases were given gastrointestinal barium X-ray examination,118 cases had no enterobiliary reflux,2 cases had intrabiliary banked gas,and 4 cases had barium reflux in biliary tract.Conclusion EST and EPBD are relatively safe and effective in treating choledocholithiasis with few complications,and they are important means for residual or recurrent gallstones.
出处
《中国实用外科杂志》
CSCD
北大核心
2000年第9期537-540,共4页
Chinese Journal of Practical Surgery
关键词
胆管残留结石
肝管复发结石
内窥镜
EST
EPBD
Endoscope Sphincterotomy Papillary balloon dilatation Residualor recurrent gallstones
