中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2011年
10期
823-825
,共3页
朱峰%宛新建%陆伦根%郑萍%李雷%罗声政
硃峰%宛新建%陸倫根%鄭萍%李雷%囉聲政
주봉%완신건%륙륜근%정평%리뢰%라성정
乳头括约肌小切开%气囊扩张术%不规则乳头%胆总管结石
乳頭括約肌小切開%氣囊擴張術%不規則乳頭%膽總管結石
유두괄약기소절개%기낭확장술%불규칙유두%담총관결석
Small endoscopic sphincterotomy%Endoscopic balloon dilatation%Atypicalanatomy papilla%Common duct stone
目的 观察乳头括约肌小切开联合气囊扩张术对不规则乳头(合并憩室50例、手术后43例、无明确病因的肠腔走行异常10例)的胆总管结石(CDS)患者的疗效.方法 2007年7月至2010年3月103例不规则乳头的CDS患者随机分为3组,3组间一般情况无显著性差异(P>0.05).34例行乳头括约肌切开术(EST组);34例行乳头气囊扩张术(EBD组);35例行乳头括约肌小切开联合气囊扩张术(EST+ EBD组).均根据实际情况在乳头治疗后行取石网篮和(或)气囊取石,部分患者以碎石网篮碎石后取石,少数巨大结石无法一次性取石仅放置塑料支架.结果 96例ERCP成功;EST小切开联合EBD与单纯EST比较,虽然一次性取石成功率无明显差异,但却显著降低了术后并发症的发生率,尤其是出血发生率(P<0.05);较单纯EBD,则显著提高了一次性取石成功率(P<0.05),减少了碎石网篮使用率,且明显降低了术后急性胰腺炎的发生率(P<0.05).结论 不规则乳头的胆总管结石患者ERCP成功率仍较高;EST小切开联合EBD对不规则乳头CDS患者维持了较高的一次性取石成功率,减少了术中、术后的并发症.
目的 觀察乳頭括約肌小切開聯閤氣囊擴張術對不規則乳頭(閤併憩室50例、手術後43例、無明確病因的腸腔走行異常10例)的膽總管結石(CDS)患者的療效.方法 2007年7月至2010年3月103例不規則乳頭的CDS患者隨機分為3組,3組間一般情況無顯著性差異(P>0.05).34例行乳頭括約肌切開術(EST組);34例行乳頭氣囊擴張術(EBD組);35例行乳頭括約肌小切開聯閤氣囊擴張術(EST+ EBD組).均根據實際情況在乳頭治療後行取石網籃和(或)氣囊取石,部分患者以碎石網籃碎石後取石,少數巨大結石無法一次性取石僅放置塑料支架.結果 96例ERCP成功;EST小切開聯閤EBD與單純EST比較,雖然一次性取石成功率無明顯差異,但卻顯著降低瞭術後併髮癥的髮生率,尤其是齣血髮生率(P<0.05);較單純EBD,則顯著提高瞭一次性取石成功率(P<0.05),減少瞭碎石網籃使用率,且明顯降低瞭術後急性胰腺炎的髮生率(P<0.05).結論 不規則乳頭的膽總管結石患者ERCP成功率仍較高;EST小切開聯閤EBD對不規則乳頭CDS患者維持瞭較高的一次性取石成功率,減少瞭術中、術後的併髮癥.
목적 관찰유두괄약기소절개연합기낭확장술대불규칙유두(합병게실50례、수술후43례、무명학병인적장강주행이상10례)적담총관결석(CDS)환자적료효.방법 2007년7월지2010년3월103례불규칙유두적CDS환자수궤분위3조,3조간일반정황무현저성차이(P>0.05).34례행유두괄약기절개술(EST조);34례행유두기낭확장술(EBD조);35례행유두괄약기소절개연합기낭확장술(EST+ EBD조).균근거실제정황재유두치료후행취석망람화(혹)기낭취석,부분환자이쇄석망람쇄석후취석,소수거대결석무법일차성취석부방치소료지가.결과 96례ERCP성공;EST소절개연합EBD여단순EST비교,수연일차성취석성공솔무명현차이,단각현저강저료술후병발증적발생솔,우기시출혈발생솔(P<0.05);교단순EBD,칙현저제고료일차성취석성공솔(P<0.05),감소료쇄석망람사용솔,차명현강저료술후급성이선염적발생솔(P<0.05).결론 불규칙유두적담총관결석환자ERCP성공솔잉교고;EST소절개연합EBD대불규칙유두CDS환자유지료교고적일차성취석성공솔,감소료술중、술후적병발증.
Objective To evaluate the effect of small endoscopic sphincterotomy and endoscopic balloon dilatation in the treatment of common duct stones (CDS) in patients with atypical papillae (combined with diverticula; after surgical operation; combined with abnormal duodenal lumen with no definite cause).Methods One hundred and three patients with CDS and with atypical papillae treated from July 2007 to March 2010 were randomly divided into three groups.Thirty-four patients received endoscopic sphincterotomy (EST group),34 patients received endoscopic balloon dilatation (EBD group) and the remaining 35 patients received small endoscopic sphincterotomy and endoscopic balloon dilatation (EST+EBD group).The general state of the patients in the 3 groups showed no significant difference (P>0.05).We tried to remove all CDS using baskets and/or balloons after the procedures on the papillae.In some patients the stones were crushed by using a basket mechanical lithotriptor (BML).In some patients with huge stones,we could only placed in a plastic stent because of the high risk of removing the stones in a single procedure.Results Successful endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 96 patients.Patients in the EST+ EBD group had less complications,especially hemorrhage,when compared with the EST group (P<0.05).Also,the EST+EBD group had a significantly higher success rate of complete stone removal (P<0.05),decreased use of BML (P<0.05) and decreased rate of acute pancreatitis when compared with the EBD group (P<0.05).Conclusions The success rate of ERCP in managing patients with CDS with atypical papillae remained high.Small endoscopic sphincterotomy and endoscopic balloon dilatation had a higher success rate of removing stones at the first attempt and a decreased rate of complications.