经T管十二指肠乳头肌扩张术治疗外科术后胆总管残余结石

Clinical study of trans-T tube duodenal papilla balloon dilatation： a novel procedure for postsurgical residual common bile duct stone

目的 评估经T管十二指肠乳头肌球囊扩张术治疗外科术后胆总管残余结石的安全性和有效性.方法 回顾性分析2010年6月至2012年4月山东大学第二医院13例接受过胆总管切开取石＋T管引流术的患者,术后发现胆总管残余结石,实施经T管十二指肠乳头肌球囊扩张术.检测术前、术后1周及1个月CA19-9、胆红素、白蛋白等指标,观察术后1周内出血、穿孔、胰腺炎、胆管炎等近期并发症,随访2年,观察结石复发及反流性胆管炎等远期并发症.分析讨论各项指标术前术后变化及各指标间相关性分析.结果 13例患者均顺利完成手术治疗.11例接受了1次手术,2例接受了2次或以上手术.术前CA19-9 （235±18）U/ml（正常＜37 U/ml）,术后1周及1个月分别降至（85±23）、（34±13） U/ml（均P＜0.01）.平均手术时间（42±15） min;围手术期胆系感染1例,胆道出血1例,无胰腺炎、胃肠道穿孔、胆道穿孔等严重并发症.术后2年结石复发2例,反流性胆管炎发生1例.结论 经T管十二指肠乳头肌扩张术是一种安全、有效的治疗手段,适用于胆总管切开取石＋T管引流术后胆总管结石残余的患者,可有效降低医患纠纷的发生率.术后出血、胰腺炎等近期并发症较少,保留了十二指肠乳头括约肌功能,有效减少反流性胆管炎的发生及结石复发,并且对各种原因所致的内镜难以操作的病例,提供了一种新的治疗途径.

Objective To investigate the safety and efficacy of trans-T tube duodenal papilla balloon dilatation for the removal of residual common bile duct stone after choledocholithotomy and T tube drainage.Methods Thirteen cases with residual common bile duct stone treated with trans-T tube duodenal papilla balloon dilatation in our department from June 2010 to April 2012 were analyzed retrospectively.Record CA19-9,bilirubin and albumin before the procedure,1 week and 1 month later.Check if immediate complications occurs,including hemorrhage,perforation,pancreatitis and cholangitis.During the following up for 2 years,stone recurrence,reflux cholangitis and other long-term complications were observed.Analyze the changes of indicators between preoperative and postoperative and the correlation.Results All of the 13 patients were treated successfully.11 patients underwent one procedure,and 2 patients received twice or more times of procedures.CA19-9 decreased significantly 1 week later and 1 month later compared with those before the procedure,while ALB was opposite.Incidences of biliary tract infection and hemorrhage were 1 and 1 respectively.No severe complications occurred,including perforation of gastrointestinal or biliary tract.Incidences of recurrent stone and reflux cholangeitis were 2 and 1 in two years after the procedure.Conclusions Trans-T tube duodenal papilla balloon dilatation is a safe and effective procedure for patients with recurrent common bile duct stone after choledocholithotomy and T-tube drainage.For the cases which could not be handled with endoscopic procedures,it provides a new therapeutic approach.