内镜下取石气囊扩张法治疗胆总管结石

Endoscopic balloon dilation for the treatment of common bile duct stones.

目的 探讨内镜下取石气囊扩张 (EBD)治疗胆总管结石的可能性、有效性及安全性。方法 对 4 7例胆总管结石患者进行了内镜下以取石气囊扩张Oddi括约肌及用气囊、网篮及机械碎石等方法取石治疗。为预防并发胰腺炎 ,术后酌情应用了善得定、鼻胆管引流及十二指肠乳头小切开等措施。结果 本组患者EBD治疗胆总管结石的成功率为 91 5 % ( 4 3 / 4 7)。一次EBD治疗后 4 1例 ( 87 2 % )结石全部取出 ,有 2例 ( 4 3 % )患者经第 2次EBD治疗后将结石全部取出 ,避免了内镜下乳头括约肌切开 (EST)。 4 7例患者中 2 7例 ( 5 7 4 % )结石直径大于 1 0cm ,施行了机械碎石术。 4例 ( 8 5 % )患者因结石太大 (≥ 2 0cm ) ,EBD治疗未成功 ,改行EST取出结石。本组患者无穿孔及出血并发症。 11例 ( 2 3 4 % )术后血清淀粉酶一过性升高 ,其中只有 1例伴有腹痛 ,经内科保守治疗迅速缓解。结论 EBD治疗胆总管结石可行、有效、安全。

Objective To evaluate the possibility,efficacy and safety of endoscopic balloon dilation(EBD)for the treatment of common bile duct stones.Methods EBD of the sphincter of Oddi and removal of the stones by balloon,basket net and mechanical lithotripsy were performed in 47 patients with common bile duct stones.In order to prevent the possible complicated pancreatitis,Sandostatin,endoscopic nasobiliary drainage(ENBD)and small sphincterotomy were used according to the patients conditions.Results The success rate of EBD for the treatment of common bile duct stones was 91 5%(43/47)in our group.During one EBD session the common bile duct was cleared in 41(87 2%)of 47 cases.Incomplete duct clearance was achieved in 2(4 3 %)cases,both of whom underwent repeated EBD with successful duct clearance without undergoing endoscopic sphincterotomy(EST).Mechanical lithotripsy was required in 27(57 4%)of the 47 cases for stones greater than 1 0cm in diameter.Failure to clear the common bile duct with EBD in 4 cases(8 5%)was primarily related to large stones size (≥2 0cm),in whom EST was required to clear the duct.No perforation or hemorrhage was observed.Temporal hyperamylasemia was observed in 11 patients,only 1 of whom was accompanied by abdominal pain,which was rapidly relieved through conservative treatment.Conclusion EBD for the treatment of common bile duct stones is possible,effective and safe.