经内镜括约肌切开或气囊扩张治疗胆总管结石_0.docVIP

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)。对于＜10mm结石采用EPBD治疗，＞11mm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。22/323例经2～3次再次取石后取净。总的并发症2.5%，其中胃肠道出血1例,胆管炎4例，胰腺炎3例。92例术后行胃肠钡餐X线检查，86例胆道内无钡剂返流，2例胆道内有积气，4例有钡剂返流入胆道。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: To assess the safety and curative effect of endoscopic sphincterotomy (EST) and papillary balloon dilatation (EPBD) for choledocholithiasis.Methods: 328 patients with choledocholithiasis were given EST or EPBD, including single biliary stone in 174 cases, two stones in 112 cases and three stones in 42 cases (one case with 20 stones). The cases with biliary stones less than 10mm were given EPBD and the cases with biliary stones larger than 11mm were given EST treatment.Results: The treatment of EST and EPBD were successful in 323 cases (98.5%) and failed in 5 cases (1.5%). After endoscopic therapy , the choledocholithiasis in 98 cases were excluded neutrally, 207 cases were given basketball or balloon to get rid of the stones. The choledocholithiasis in 14 cases were discharged with basketball lithotripsy, in 4 cases were given lithotripsy. The choledocholithiasis in 22 of 323 cases were gotten rid of thoroughly after bEing treated for 2-3 times. Total complications were noted in 2.5% of these cases. Hemorrhage of gastrointestinal tract occurred in 1 case, cholangitis in 4 cases and pancreatitis in 3 cases. 92 cases were given gastroenteric barium X-ray examination, 86 cases had no barium reflux in biliary tract, 2 cases had intrabiliary banked gas, 4 cases had barium reflux in biliary tract.Conclusions: EST and EPBD are relatively safe and effective procedure in treating choledocholithiasis with few complications. 　　Key Words: Choledocholithiasis; Endoscope; Sphincterotomy; Papillary Balloon Dilitation 　　随着胆石病发病率增加，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(Endos