摘要
目的探讨十二指肠乳头括约肌小切开联合大球囊扩张术(SEST+EPLBD)治疗难治性胆总管结石的效果和安全性,以及结石大小、数量、机械碎石与并发症之间的关系。方法对2009年1月至2012年11月我院收治的106例难治性胆总管结石患者先行乳头小切开(SEST),再行大球囊扩张术(EPLBD),然后行胆总管取石术的病例资料进行回顾性分析。结果 95例一次取石成功,8例经两次ERCP操作后取石成功,3例取石失败;术后无穿孔及重症急性胰腺炎发生,术后4例出现胆道感染,3例出现轻型胰腺炎,2例死亡。结果发现:结石大小及数量与操作次数及并发症间无明显相关性(P>0.05);机械碎石在结石直径超过2 cm的患者中使用率明显增高(P<0.05);采用机械碎石的患者并发症发生率有增高趋势,但差异无统计学意义(P>0.05)。结论乳头小切开联合大球囊扩张术治疗难治性胆总管结石成功率及安全性较高,总体并发症发生率低,有一定应用价值。
To evaluate the efficacy and safety of small endoscopic sphincterotomy combined withendoscopic papillary large balloon dilation （SEST ＋EPLBD） t0r patients with intractable choledocholithxasis, and try to find the relationships between the number and size of the stones and either complications or mechanical lithotripsy, as well as the relationship between mechanical lithotripsy and complications. Methods From Jan. 2009 to Nov. 2012, 106 patients diagnosed as intractable choledocholithiasis had received SEST＋EPLBD and stone removal in our hospital and the related data were retrospectively analyzed. Results Complete stone removal was obtained with one session in 95 patients and two sessions in 8 cases, and failed in 3 cases. There was no perforation and severe acute pancreatitis occurred postoperatively, but cholangitis occurred in 4 patients and mild pancreatitis occurred in 3 patients. Two patients died postoperatively. We found that： the number and size of the stones have no significant relationship with the number of sessions needed and the rate of complications （P〉 0.05）; mechanical lithotripsy was used more frequently in patients with a stone 〉2 cm in diameter （P〈0,05）; patients undergone mechanical lithotripsy were more likely to have higher occurrence rate of total complications, even though the results were not statistically significant （P〉0.05）. Conclusion SEST＋EPLBD is a valuable method for patients suffered from intractable choledocholithiasis with a high successful rate and safety and low occurrence rate of complications.
出处
《肝胆胰外科杂志》
CAS
2013年第5期353-356,共4页
Journal of Hepatopancreatobiliary Surgery
基金
上海中医药大学附属普陀医院培英计划(2013SR137 II)
