EST治疗胆总管良性病变327例分析

The Application of Endoscopic Sphincterotomy for Benign Choledochal Diseases:A Report of 327 Cases

目的：探讨内镜下乳头括约肌切开术（EST）治疗胆总管良性病变的适应症及并发症的防治体会。方法：回顾性分析我院在1997年12月-2006年12月进行EST治疗的327例胆总管良性病变患者临床资料。对胆总管结石或蛔虫患者通过EST取石或取虫;对有胆总管下端狭窄或其它胰-胆管异常患者作EST引流;对急性梗阻性化脓性胆管炎和急性胆源性胰腺炎患者在EST术后均另常规放置鼻胆管引流。结果：有95.4%（312/327）的患者插管成功。发现有胆总管内结石209例,胆总管内蛔虫15例。术后复查B超见结石或蛔虫清除率86.2%（193/224）。术后黄疸、腹痛、发热等症状缓解率在93.9%（307/327）。平均操作时间在20-50min。术后并发症有10例急性胆管炎;6例急性胰腺炎;3例胆道出血,总的并发症发生率在0.59%（19/327）。经治疗后均很快好转。结论：EST适用于胆总管良性病变,其创伤小、出血少、愈合快,同时最大限度保留乳头括约肌的功能。术中操作熟练,术后处理准确,可大大降低并发症的发生。

Objective：To evaluate the therapeutic effects and the prevention of complication of endoscopic sphincterotomy（EST）for benign choledochal diseases.Methods：The clinical data of 327 patients with benign choledochal diseases were performed by EST under endoscopic retrograde cholangiopancreatography（ERCP）from December 1997 to December 2006 in our hospital were analyzed retrospectively.EST was carried out if stones or ascaris has found in the common bile duct.Endoscopic naso-billiary drainage（ENBD）was performed after EST in patients with acute obstructive suppurative cholangitis and acute biliary pancreatitis.Results：Those who received ERCP plus EST 95.4% were successfully.The overall rate of occurence of stone or ascaris from EST was 86.2%.The major symptom mitigated in 93.9% patients.The operating time was 20～50 min.Postoperative complications included acute cholangitis in 10 cases,acute pancreatitis in 6,and significant hemobilia in 3.All of the patients recovered after treatment.Conclusion：EST is a safe and effective method for treating benign choledochal diseases.It hadmany advantages such as less damage,less suffering,rapid recovery and preserved the function of Oddi sphincter.Careful operation and postoperative management was key to reduce the incidence of serious postoperative complications.