十二指肠乳头部微胆石的内镜诊治

Endoscopic treatment of biliary microlithiasis in duodenal papilla

目的探索十二指肠乳头部微胆石的内镜诊治方法和价值。方法对反复胆绞痛、术后再发胆绞痛、特别是发生急性胰腺炎者进行内镜乳头切开,观察乳头有无排石,收集胆汁进行显微镜检。结果在完成内镜检查治疗的319例患者中发现微胆石34例(10.7%,34/319);依来源分:胆囊型(Ⅰ型)8例,胆管型(Ⅱ型)7例,胆囊胆管混合型(Ⅲ型)19例。单纯内镜治疗26例;内镜联合胆囊切除8例。结论微胆石临床发病率不高,但危害和风险大,内镜是最有效的诊断和治疗方法,Ⅰ型和Ⅲ型可联合切除胆囊。

Objectives To explore the endoscopic diagnosis and treatment of occult microlithiasis. Methods Endoscopic sphincterotomy （EST） was performed for recurrent biliary colic, postoperative occurrence of biliary colic, and patients with acute pancreatitis , the row stones falled down into the duodenum were observed, and the bile was collected for microscopic examination. Results Three hundred and nineteen patients with biliary and pancreatic diseases were treated endoscopic sphincterotomy（EST） during December 2007-January 2010, 34 patients （10.7%） were found to have biliary microlithiasis. According to the composition of microlithiasis, three types were classified： type I （located in gallbladder, 8 cases）, type II （ located in bile duct, 7 cases）, and type III （located both in gallbladder and bile duct, 19 cases）. Twenty six patients were treated by endoscopy only, remaining patients by endoscopy combined with cholecystectomy. Conclusion The incidence of biliary microlithiasis was low in clinical practice, but it was a high-risk factor for other potential diseases. Endoscopy was the most effective method in diagnosis and treatment of biliary microlithiasis. As for type I and type III, EST combined with cholecystectomy was recommended.