毕Ⅱ式胃大部切除术后乳头球囊扩张术治疗胆总管结石的疗效

Endoscopic papillary balloon dilation in management of common bile duct stones after Billroth Ⅱ gastrectomy

目的:探讨内镜下乳头球囊扩张术(endoscopic papillary balloon dilatation,EPBD)治疗毕Ⅱ式胃大部切除术后胆总管结石的有效性、安全性及可行性.方法:术前所有患者均常规行普通胃镜检查,术中十二指肠镜下寻找乳头,行内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopa ncreatography,ERCP)造影,导丝引导下对16例毕Ⅱ式胃大部切除术后胆总管结石经乳头球囊扩张后用取石网篮取石.结果:16例患者其中15例成功取净结石,1例因乳头旁憩室过大无法完成造影而放弃治疗.无ERCP相关严重并发症.结论:经EPBD治疗毕Ⅱ式胃大部切除术后胆总管结石患者费用低、并发症少、疗效满意.对毕Ⅱ式胃大部切除术后患者,既解除了结石引起的胆道梗阻,又避免了再次外科手术,是一种安全有效的微创治疗方法.

AIM： To assess the effectiveness, safety and feasibility of endoscopic papillary balloon dilation （EPBD） in the management of common bile duct stones after Billroth Ⅱ gastrectomy. METHODS： A total of 16 patients with common bile duct stones after Billroth Ⅱ gastrectomy were included. All patients underwent conventional gastroscopy preoperatively, duodenoscopy intraoperatively for identifying duodenal papilla, endoscopic retrograde cholangiopancreatography （ERCP） for imaging, and endoscopic papillary balloon dilation to remove stones with stone basket. RESULTS： Operation was successful in 15 of 16 cases. One case could not complete the imaging due to too large juxtapapillary diverticulum and gave up the treatment. There were no severe complications in all the 15 cases. CONCLUSION： EPBD is safe, effective, and minimally invasive in the treatment of common bile duct stones after Billroth Ⅱ gastrectomy, avoiding the second surgical operation and relieving obstruction caused by stones.