经内镜括约肌切开或气囊扩张治疗胆总管结石.doc

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1、经内镜括约肌切开或气囊扩张治疗胆总管结石目的：探讨经内镜括约肌切开(EST)和内镜乳头气囊扩张(EPBD)治疗胆总管结石的安全性和疗效。方法：经EST和EPBD共治疗胆总管结石328例，其中单颗结石174例，2颗结石112例，3颗以上结石42例(最多1例20颗结石)o对于<10mm结石采用EPBD治疗，>llmm采用EST。结果：治疗成功323例，占98.5%,失败5例。其中98例经内镜治疗后结石自然排出，207例采用网篮或取石球囊取出结石，14例采用碎石网篮碎石后排出，4例经震波碎石后取出o22/323例经2~3次再次取石后取净。总的并发症2.5%,其中胃肠道

2、出血1例,胆管炎4例，胰腺炎3例。92例术后行胃肠钥餐X线检查，86例胆道内无根剂返流，2例胆道内有积气，4例有钥剂返流入胆道。结论:EST和EPBD安全，有效，并发症少，是目前治疗胆总管结石的重要手段之一。Objective:Toassessthesafetyandcurativeeffectofendoscopicsphincterotomy(EST)andpapillaryballoondilatation(EPBD)forcholedocholithiasis.Methods:328patientswithcholedocholithiasiswereg

3、ivenESTorEPBD,includingsinglebiliarystonein174cases,twostonesin112casesandthreestonesin42cases(onecasewith20stones).Thecaseswithbiliarystoneslessthan10mmweregivenEPBDandthecaseswithbiliarystoneslargerthan11mmweregivenESTtreatment.Results:ThetreatmentofESTandEPBDweresuccessfulin323cas

4、es(98.5%)andfailedin5cases(1.5%).Afterendoscopictherapy,thecholedocholithiasisin98caseswereexcludedneutrally,207casesweregivenbasketballorballoontogetridofthestones.Thecholedocholithiasisin14casesweredischargedwithbasketbal11ithotripsy,in4casesweregivenlithotripsy.Thecholedocholithia

5、sisin22of323casesweregottenridofthoroughlyafterbeingtreatedfor2~3times.Totalcomplicationswerenotedin2.5%ofthesecases.Hemorrhageofgastrointestinaltractoccurredin1case,cholangitisin4casesandpancreatitisin3cases.92casesweregivengastroentericbariumX-rayexamination,86caseshadnobariumreflu

6、xinbi1iarytract,2caseshadintrabi1iarybankedgas,4caseshadbariumrefluxinbiliarytract.Conclusions:ESTandEPBDarerelativelysafeandeffectiveprocedureintreatingcholedocholithiasiswithfewcomplications.KeyWords:Choledocholithiasis;Endoscope;Sphincterotomy;Papi1laryBal1oonDi1itation随着胆石病发病率增加，

7、术后胆道残留或复发性结石已屡见不鲜。我院近13年来采用经内镜括约肌切开(EndoscopicSphincterotomy,EST)或内镜乳头气囊扩张术(EndoscopicPapi11aryBalloonDilatation,EPBD)共治疗胆总管结石328例,323例结石完全排出，疗效满意。当胆总管结石病人经内镜治疗后，我们按结石的大小分别采用自然排石、网篮和取石球囊取石、碎石篮机械碎石和体外震波碎石等处理不同类型的结石，取得了明显的疗效，现报告如下。1临床资料和方法1.1一般资料自1986年3月〜1999年7月，我院采用内镜治疗胆总管结石328例，其中胆总管

8、切开T管引流术和胆囊切除