胆总管结石乳头部嵌顿的内镜治疗

Endoscopic treatment for a bile duct stone impacted at the duodenal papilla

目的胆总管结石十二指肠乳头部嵌顿是一种临床急诊,可能引起胆胰管流出道的几乎完全梗阻,导致急性梗阻化脓性胆管炎和胰腺炎。该文研究其临床特征和内镜疗效。方法回顾性分析182例确诊的胆总管结石十二指肠乳头部嵌顿患者。结果具有典型的急性胆管炎Charcot三联征的患者98例(53.9%),急性胰腺炎86例(47.3%)。ERCP发现120例(65.9%)为单枚结石嵌顿于十二指肠乳头,62例胆管内尚有1至数枚结石。所有患者都通过内镜下十二指肠乳头括约肌切开术(EST)取石成功,其中标准EST成功30例(16.5%),针形刀乳头剖开术(NKF)成功152例(83.5%)。并发症主要是出血(12例,6.59%)。结论胆总管结石十二指肠乳头部嵌顿必须通过临床表现和ERCP检查才能确诊,内镜治疗是安全有效的方法。

【Objective】A bile duct stone impacted at the duodenal papilla is an urgent condition that can rapidly lead to either suppurative cholangitis or acute pancreatitis due to almost complete obstruction of the bilio-pancreatic outflow. This study was to evaluate the clinical characteristics and results of endoscopic treatment for a bile duct stone impacted at the duodenal papilla. 【Methods】One hundred and eighty-two patients who had been diagnosed as impacted papillary stone were retrospectively reviewed.【Results】The typical features of acute cholangitis (Charcot's triad) and pancreatitis were observed only in 98 patients (53.9%) and 86 patients(47.3%) respectively. After the endoscopic retrograde cholangiopancreatography, 120 patients (65.9%) were found to have a solitary stone impacting the duodenal papilla and 62 patients had one or more stones in the bile duct. All impacted papillary stones were successfully removed by endoscopic sphincterotomy: 152 patients (83.5%) by a needle knife and 30 patients (16.5%) by a pull type papillotome. The procedure-related complications (12 patients, 6.59%) were bleeding.【Conclusion】 A bile duct stone impacted at the duodenal papilla requires both clinical and radiographic evidence to support the diagnosis. Endoscopic sphincterotomy, either with a needle knife or a pull type papillotome, was safe and effective for removing the impacted papillary stone.