内镜扩约肌切开术治疗胆总管继发性结石

Endoscopic sphincterotomy in treatment of secondary common bile duct stones

目的评价逆行胰胆管造影术（ＥＲＣＰ）和内镜括约肌切开术（ＥＳＴ）在腹腔镜胆囊切除前后诊断和治疗胆总管继发结石中的作用．方法采用ＥＲＣＰ和ＥＳＴ在ＬＣ术前或术后诊断和治疗胆总管继发结石２２８例，其中包括ＬＣ术前发现的１８５例和术后确诊的４３例．常规ＥＲＣＰ检查，证实胆总管内有结石后行ＥＳＴ．然后根据结石形态、大小和数目不同采取不同方法处理结石．①自然排石，适合于直径在０３ｃｍ～０８ｃｍ的结石；②取石网篮取石，适合于直径在０９ｃｍ～１５ｃｍ的结石；③碎石篮碎石，适宜直径大于１５ｃｍ以上的结石．结果全部２２８例患者中，ＥＳＴ成功２１７例（９５２％），胆总管结石完全排出２０９例（９１７％），发生各种并发症１９例（８８％），主要并发症为急性胰腺炎、急性胆管炎和Ｏｄｄｉ扩约肌切口渗血，全部经非手术治疗愈合，无死亡病例．结论ＥＲＣＰ和ＥＳＴ是ＬＣ术前和术后诊治胆总管结石安全有效的方法之一．

AIM To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) in treatment of secondary common bile duct stones. METHODS Two hundred and twenty eight patients with secondary common bile duct stones were treated by ERCP and EST prior to laparoscopic cholecystectomy (LC) or after the operation. The stones were managed by different methods according to the shape, number and diameter of calculi. RESULTS The EST procedure was successful in 217 of 228 patients(95 2%) and stones were cleared in 209 patients (91 7%). Complications of ERCP/ EST occurred in 19 patients (8 8%) including acute cholangitis, mild pancreatitis and gastrointestinal hemorrhage. All were healed without surgical intervention and no death occurred. CONCLUSION ERCP/ EST is a safe and effective technique for treatment of secondary common bile duct stones in LC.