经十二指肠镜治疗胆总管大结石

Endoscopic sphincterotomy for the treatment of common bile duct stones

目的 探讨经十二指肠行逆行胆胰管造影（ERCP）及内镜下十二指肠乳头括约肌切开术（EST）取石对胆总管大结石病人的治疗价值。方法 本组21例胆总管大结石病人应用ERCP及EST，采用碎石取石网篮即时取石，较大结石采用机械碎石后取出。结果21例胆总管结石病人全部行EST，一次取尽结石14例（66．7％），二次取尽结石5例（22．8％），因碎石过多难以取尽1例（4．8％），1例因结石过大放弃治疗，取石成功率为90．5％，其中碎石治疗17例（81．0％），一次碎石成功13例（76．5％）。2次碎石成功3例（17．6％），1例因结石过大而放弃，碎石成功率94．1％。结论 经十二指肠镜治疗胆总管大结石是行之有效的好方法，多可避免外科手术治疗。

AIM To investigate the therapeutic effect of endoscopic sphincterotomy （EST） on common bile duct stones. METHODS EST was performed on 21 patients with at least onestone of more than 15 mm in diameter after endoscopic retrograde cholangiopancreatography （ERCP）. Stones were removed with trapezoidrx and mechanical lithotripsy was employed if necessary. RESULTS Stones were totally removed in 90.5% （19/21.） patients.One patient had too many stones and another had one stone too big to be removed. CONCLUSION Endoscopic sphincterotomy with mechanical lithotripsy is an effective approach to common bile duct stones of more than 15 mm in diameter.