柱状大水囊扩张术治疗合并十二指肠乳头旁憩室者胆总管较大结石的初步探讨

Endoscopic large balloon papillosphincteroplasty for difficult bile duct stones combined with peripapillary diverticulum

目的初步探讨内镜下十二指肠乳头柱状大水囊扩张术对合并十二指肠乳头旁憩室胆总管较大结石患者的安全性和治疗价值。方法对21例合并十二指肠乳头旁憩室且胆总管结石直径较大的患者先行EST，切开3～6mm，用直径10mm的球囊扩张，再根据胆总管直径以及结石大小分别应用直径16～20mm的柱状水囊扩张器行乳头扩张，随后予以取石网篮和（或）取石气囊将结石完整取出。结果所有患者均经一次操作取出结石，均未使用碎石器碎石。取出结石直径1．3～2．0cm，平均1．6cm，单发结石患者15例，2枚结石患者4例，3枚结石患者2例。2例患者术后并发轻型急性胰腺炎，2例术后有一过性血淀粉酶升高，但均低于正常值上限3倍；未发生穿孔、明显出血、感染等并发症。结论对于合并十二指肠乳头旁憩室且胆总管结石较大的患者，十二指肠乳头柱状大水囊扩张术是一种安全有效的治疗方法。

Objective To evaluate the effects and safety of endoscopic large balloon papillosphincteroplasty for difficult bile duct stones combined with peripapillary diverticulum. Methods Endoscopic sphincterotomy （EST） to 3-6 mm was performed in 21 patients with large bile duct stones combined with peripapillary duodenal diverticulum, after which the incision was dilated with a 10mm balloon, followed by endoscopic papillosphincteroplasty with a TTC balloon dilator of 16-20 mm in diameter according to the size of the dilated common bile duct and the stones. Then the stones were removed with a basket and/or a retrieval balloon. Results All the stones were removed with one endoscopic procedure without mechanical lithotripsy. The size of removed stones ranged from 1.3 to 2. 0 cm （mean 1.6 cm） , with 15 cases of single stone, 4 of 2 stones and 2 of 3 stones. Mild post-operative pancreatitis occurred in 2 patients and transient serum amylase elevation （ less than 3 times of normal upper range） was found in 2 other patients. There were no such procedure related complications as perforation, massive hemorrhage or infections. Conclusion Endoscopic large balloon papillosphincteroplasty is efficacious and safe for difficult bile duct stones combined with peripapillary duodenal diverticulum.