胆总管结石合并十二指肠乳头旁憩室对经内镜逆行胰胆管造影的影响及应对策略

Effect of Common Bile Duct Stones Combined with Duodenal Papillary Diverticulum on Endoscopic Retrograde Cholangiopancreatography and Coping Strategies

目的探讨胆总管结石合并十二指肠乳头旁憩室对经内镜逆行胰胆管造影(ERCP)的影响及应对策略。方法回顾性分析2016年1月—2019年2月就诊于该院的72例胆总管结石合并十二指肠乳头旁憩室患者临床资料,均行经内镜逆行ERCP,分析胆总管结石合并十二指肠乳头旁憩室对ERCP影响。结果72例胆总管结石合并十二指肠乳头旁憩室患者经内镜逆行ERCP成功率为97.22%(70/72),其余2例转行手术。72例患者行十二指肠乳头括约肌切开术(EST)取石47例(67.14%),单纯实施柱状气囊扩张取石6例(8.57%),实施EST联合柱状气囊扩张术后取石17例(24.29%);胆总管结石1次取净67例(95.71%);经碎石器碎石6例(8.57%);术后放置鼻胆管42例(60.00%),因结石较大难以取出者3例(4.29%),对其实施塑料支架引流,术后3~6个月均取石成功;术后并发症发生率为7.14%(5/70),其中一过性胆管炎1例(1.43%),胰腺炎3例(4.29%),乳头EST术后出血1例(1.43%),未出现死亡与穿孔病例。结论胆总管结石合并十二指肠乳头旁憩室经内镜逆行ERCP成功率较高,操作者需小心、细心、耐心且术中选择有效策略,以减少相关并发症的发生,提高造影安全性。

Objective To investigate the effect of common bile duct stones combined with duodenal papillary diverticulum on endoscopic retrograde cholangiopancreatography(ERCP)and its coping strategies.Methods A retrospective analysis of 72 patients with common bile duct stones and duodenal papillary diverticulum from January 2016 to February 2019 was performed.All patients underwent endoscopic retrograde ERCP and analyzed common bile duct stones with twelve fingers.The effect of the intestinal papillary diverticulum on ERCP.Results The success rate of endoscopic retrograde ERCP in 72 patients with common bile duct stones and duodenal papillary diverticulum was 97.22%(70/72),and the other 2 patients underwent surgery.Seventy-two patients(67.14%)underwent duodenal papillary sphinctertomy(EST),6 patients(8.57%)underwent columnar balloon dilatation,and 17 patients underwent EST combined with columnar balloon dilatation(24.29%);67 cases(95.71%)were taken from the common bile duct stones;6 cases(8.57%)were treated with lithotripsy;42 cases(60.00%)were placed in the nasal bile duct after operation,and it was difficult to remove due to large stones of 3 cases(4.29%),plastic stent drainage was performed,and stone was successfully performed 3-6 months after operation.The postoperative complication rate was 7.14%(5/70),including one case of transient cholangitis(1.43%).3 cases of pancreatitis(4.29%),1 case of postoperative nipple EST(1.43%),no death and perforation cases.Conclusion The success rate of endoscopic retrograde ERCP in common bile duct stones combined with duodenal papillary diverticulum is higher.Operators need to be careful,and choose effective strategies to reduce the occurrence of related complications and improve the safety of angiography.