摘要
目的 探讨十二指肠乳头括约肌小切开及球囊扩张治疗肝外胆管结石的临床价值.方法 将我院2008年10月～2011年2月收治的肝外胆管结石患者128例,随机分为两组：（1）十二指肠乳头括约肌小切开加内镜乳头球囊扩张术（EST＋EPBD）组65例：男39例,女26例,年龄45～77岁;原发性肝外胆管结石46例,胆囊结石合并肝外胆管结石12例,行单纯胆囊切除术后肝外胆管结石7例.在括约肌小切开后,以10～15 mm球囊扩张乳头部,然后进行相应的碎石或取石操作.（2）乳头括约肌切开组（EST组）63例：男37例,女26例,年龄33～78岁;原发性肝外胆管结石51例,胆囊结石合并肝外胆管结石9例,行单纯胆囊切除术后肝外胆管结石3例.采用单纯乳头切开,加取石治疗.结果 EST＋EPBD组取石成功率为98.46%（64/65）,有1例因结石太大无法套住转开腹手术;EST组取石成功率为95.24%（60/63）,有3例取石失败,原因为：1例结石大无法套住,另2例的乳头太小,而结石偏大（直径1.2~1.5 cm）、太硬难以粉碎,未能取出,安放鼻胆管引流后,家属要求外科手术,3例均外科手术取石.EST＋EPBD 组与EST组的取石成功率无显著性差异（P＞0.05）,EST组所需机械碎石例数均高于EST ＋EPBD组（9.23% vs.3.33%,P＜0.01）.两组近期并发症发生率（包括胰腺炎3.08% vs.1.59%、高淀粉酶血症9.23% vs.7.93%、出血1.54% vs.6.35%）无显著性差异（P＞0.05）,无活动性消化道穿孔、出血及死亡病例.结论 十二指肠乳头括约肌小切开后球囊扩张治疗胆总管结石安全有效,且保留了括约肌功能.
Objective To discuss the clinical value of endoscopic papillosphincterotomy and balloon dilation in the treatment of extrahepatic bile duct calculi. Methods 128 patients with extrahepatic bile duct calculi who received the treatment between October 2008 and February 2011 were randomly divided into two groups. Sixty five patients （39 male and 26 female, aged from 45-77） received the endoscopic papillosphincterotomy plus endoscopic papilla balloon dilation （ EST ＋ EPBD group）. Those cases included 46 of primary extrahepatic bile duct calculi, 12 of gallstones complicated with bile duct calculi, and 7 of extrahepatic bile duct stone after simple cholecystectomy. After the sphincterotomy, the papilla sites were dilated by the balloon with the diameter of 10-15 mm, and then stone breaking and removing were carried out. Sixty three cases received the endoscopic papillosphincterotomy （37 males and 26 females, aged from 33-78） （EST group）. Those cases included 51 ones of primary extrahepatic bile duct calculi,9 of gallstones complicated with extrahepatic bile duct calculi, and 3 of extrahepatic bile duct stones after cholecystectomy. The treatment was simple papilla incision plus calculus removing. Results The success rate of stone removing in EST ＋ EPBD group was 98.46% （64/65）. Only one case accepted laparotomy because the stones were too big to be traped. The success rate of stone removing in EST group was 95.24% （60/63）, and the operation failed in 3 cases. In one case, the stones were too big to be traped. In the other two cases, the papillae were too small and the stones were too big （with the diameter of 1.2-1.5 cm） and hard to be taken out. After the placement of nasobiliary drainage, their family members required surgical treatment. All the three cases received the surgical lithotripsy. There was no significant difference in the success rate between the two groups （ P 〉 0.05）. The percentage of patients who accepted mechanical lithotripsy in EST group was higher than that in
出处
《西南国防医药》
CAS
2014年第3期271-273,共3页
Medical Journal of National Defending Forces in Southwest China
关键词
十二指肠乳头括约肌
小切开
球囊扩张术
肝外胆管结石
sphincter of duodenal papilla
small incision
balloon dilation
extrahepatic bile duct calculus
