ERCP、EST、ENBD治疗胆总管结石391例临床分析

Treatment of Choledocholithiasis with ERCP,EST and ENBD in a Report of 391 Cases

目的总结应用逆行胰胆管造影术(ERCP)、内镜括约肌切开术(EST)和鼻胆管引流术(ENBD)治疗胆总管结石的疗效。方法胆总管结石患者391例,常规行ERCP检查,证实胆管内有结石后行EST。然后根据结石情况采取不同方法处理。(1)结石直径小于1.0cm的315例用取石网篮取石;(2)结石直径大于1.0cm的61例用碎石篮碎石;(3)6例巨大结石而于胆管内置入支架3个月。术后所有病人常规置入鼻胆引流管。结果EST成功382例(97.70%),胆总管结石完全取出367例(96.07%)。发生各种并发症35例(8.95%),主要为急性胰腺炎、急性胆管炎和Oddi扩约肌切口渗血,未成功病例和一例重症胰腺炎转开腹手术治疗治愈。结论ER-CP、EST和ENBD诊治胆管结石特别是胆总管结石,安全、有效,病人痛苦小。

Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography（ERCP） ,endoscopic sphincterotomy（EST） and endoscopic naso-biliary drainage（ENBD） in choledocholithiasis. Methods 391 cases underwent ERCP for the confirmation of bile duct stone and the subsequent EST to remove the stones. The stones were removed via varied approaches including lithobasket removing in 315 cases with stones less than 1 cm in diameter, lithoclast in 61 cases with stones more than 1 cm in diameter,6 cases with huge stones were placed with stent for 3 months. All the patients were treated with endoscopic naso-biliary drainage. Results EST was successfully performed in 382 cases, complete removal of stones achieved in 367 cases. Complications occurred in 35 cases including acute pancreatitis,acute cholangitis and staxis of Oddi sphincter incision. Failed cases and 1 case of severe acute pancreatitis underwent laparotomy and cured. Conclusion Combination of ERCP, ENBD and EST is safe, effective and painless for choledocholithiasis.