内镜Oddi括约肌切开术适应证的商榷

A discussion on indications of endoscopic sphincterotomy

目的探讨内镜Oddi括约肌切开术（endoscopic sphincterotomy，EST）适应证的规范合理范围。方法回顾分析我院2005年1月-2006年1月EST适应证有争议的病例9例，包括肝炎合并肝内胆汁淤积性黄疸1例、肝内外胆管结石1例、胆总管结石1例、胆道下段及上段肿瘤性梗阻各1例、十二指肠乳头肿瘤2例、胆总管囊肿1例、胆囊结石合并胆总管结石1例。结果除1例内科黄疸被误诊外，其余8例均为外科治疗的适应证，其中5例EST后又行手术治疗，1例因EST后病情加重而失去手术机会，2例晚期肿瘤行EST后放弃根治手术。结论未能解除胆道上游狭窄病变者，EST不能达到治疗目的，并可能增加疾病风险；可以手术切除的肿瘤EST可能没有必要；年轻患者EST应慎重。

Objective To investigate proper indications of endoscopic sphincterotomy （EST）. Methods A retrospective review was made on 9 cases of EST with controversial indications from January 2005 to January 2006 in this hospital. There were 1 case of jaundice due to hepatitis and intrahepatic cholestasis, 1 case of intrahepatic and extrahepatic cholelithiasis, 1 case of common bile duct stones, 2 cases of bile duct obstruction due to malignant tumors at upper （ 1 case） or lower segment （ 1 case） , 2 cases of papillary tumors, 1 case of choledochal cyst, and 1 case of gallstones accompanying common bile duct stones. Results Except for 1 case of jaundice due to hepatitis and intrahepatic cholestasis misdiagnoed as having obstructive jaundice, surgical indications presented in 8 cases. Of the 8 cases, 5 cases were given a surgical operation following EST, 1 case was inoperable because of worse general condition after EST, and a radical operation was given up in 2 cases of end-stage tumors. Conclusions Without complete relief of proximal bile duct obstruction, EST may worsen the patient＇ s condition instead of curing the biliary diseases. EST may be unnecessary for reaectable tumors, especially in young patients.