经内镜乳头括约肌切开（EST）治疗胆总管结石326例临床分析

Clinical analysis of 326 cases of choledocholithiasis treated with endoscopic sphincterotomy

目的 探讨内窥镜下十二指肠乳头括约肌切开术（EST）对胆总管结石的治疗效果.方法 总结1990年10月至2009年1月间实施的326例次内窥镜十二指肠乳头括约肌切开（EST）治疗胆总管结石的经验,并对其中195例病人进行长期随访.结果 EST治疗胆总管结石326例,结石排出301例（92.3%）.内窥镜十二指肠乳头括约肌切开术后发生并发症20例（6.13%）,其中急性胰腺炎10例（3.07%）,术后出血7例（2.14%）,急性胆管炎4例（1.22%）,十二指肠穿孔1例（0.09%）,病死1例.随访结果,发生反流性胆管炎20例（10.25%）,结石复发18例（9.23%）.结论 经内镜括约肌切开治疗胆总管结石创伤小、安全性高、疗效满意、术后恢复快,是一种理想的微创外科方法.

Objective To investigate the therapeutic efficacy of endoscopic sphincterotomy （EST） for treatment of choledocholithiasis. Methods The clinical data of 326 patients receiving EST from July 1990 to January 2009 were retrospectively analyzed. Long-term follow-up was performed in 195 of the 326 patients. Results The common bile duct stones were removed in 301 cases （92. 33%）.The occurring rate of complications after EST was 6.13% （20/326）. Of the 20 patients, 10 had pancreatitis （3.07%）, 7 hemorrhage （2. 14%）, 4 cholangitis （1. 220%） and 1 duodenal perforation （0.09%）. Only 1 patient died. The follow-up showed that 20 patients had reflux cholangitis and 18 recurrence of common bile duct stones. Conclusion Therapeutic endoscopy is safe and effective for treatment of choledocholithiasis.