内镜下十二指肠乳头括约肌切开术与开腹手术联合治疗伴乳头功能紊乱的胆管结石

The combined endoscopic sphincterotomy and surgical operation for the treatment of bile duct stones and the sphincter of oddi dysfunction.

目的 :介绍联合应用EST及外科手术处理内镜下治疗困难的伴有乳头功能紊乱的胆管结石。方法 :本组 5例病人先行ERCP了解胆管结构、结石大小、部位及乳头排空情况 ,后行EST及胆管探查取石术。结果 :所有病人术后T管造影均示乳头排空良好。无胆管炎再发。结论 :建议对所有胆管结石病人先行ERCP ,对内镜下治疗困难且伴有乳头功能紊乱者联合应用EST及外科治疗无需重建消化道 ,是一种有效的治疗方法。

Objective:In order to introduction the treatment useing the combined EST and surgical operation in patients with bile duct stones and sphincter of oddi dysfunction in whom endoscopic managment proves difficult.Methods:ERCP in 5 patients show duct anatomy,size,position of stones and contrast medium excretion,followed by EST and the common bile duct exploration and stones removal.Results:After operation in all patients cholangiograph through T tube show well for contrast medium excretion,no cholangeitis recur after treatment.Conclusions:We recommend the use of ERCP in patients with bile duct stones before operation.It is a useful therapeutic method in patients with bile duct stone and sphincter of oddi dysfunction in whom endoscopic managment proves difficult to combined EST and surgical operation,without reconstruct of gastrointestinal tract.