食管型柱状大气囊扩张治疗EST术后胆总管结石复发疗效观察

Endoscopic papillary large balloon dilation for the treatment of recurrent bile duct stones in patients with prior sphincterotomy

目的探讨应用食管型柱状大气囊扩张十二指肠乳头治疗既往曾行EST术的复发性胆总管结石患者的安全性及治疗价值。方法回顾分析2010年9月～2011年7月我院16例既往有EST史的复发性胆总管结石的患者,所有患者均行EPLBD使十二指肠乳头扩张并在此基础上进行治疗。结果 16例患者中,6例患者(37.5%)伴有乳头旁憩室,3例患者(18.8%)有高血压,1例患者(6.3%)有肝硬化,其中3例患者应用了碎石器碎石,13例患者仅一次就取净结石,其中单发结石7例,多发结石8例,术后合并有胰腺炎1例,合并有穿孔1例,经内科保守治疗治愈,未合并有消化道大出血、死亡等严重并发症。气囊的大小为12～15mm,扩张的持续时间为30～40s。结论对于既往曾行EST术的复发性胆总管结石的患者,EPLBD是有效而安全的,尤其是多发及较大的胆总管结石,值得临床进一步推广。

Objective To evaluate the safeyt and therapeutic value of EPLBD in patients with recurrent common duct stones who underwent EST previously.Methods From Sep 2010 to Jul 2011,16 patients with recurrent bile duct stones who had a history of EST were studied retrospectively.All patients underwent EPLBD without additional EST to enlarge the ampullary orifice to perform the therapy.Results Of the 16 patients,there were 6 patients （37.5%） with periampullary diverticula,3 patients （18.8%） with hypertension,1 patients （6.3%） with liver cirrhosis.Complete clearance of the duct was achieved in all patients and mechanical lithotripsy was needed in 3 patients.13 cases required only 1 session of ERCP to achieve complete ductal clearance.Mild pancreatitis occurred in 1 patient,but there was no bleeding,there was perforation in one patients..The size of the balloon for EPLBD was 12～15 mm and the duration of the balloon dilatation was 30～40s.Conclusion EPLBD is an effective and safe method for the treatment of recurrent common duct stones in patients with prior EST.