目的通过随机对照试验评估内镜下十二指肠乳头肌切开术(EST)治疗无胆总管结石的急性胆管炎的疗效。方法经ERCP证实无胆总管结石和无肿瘤梗阻的急性胆管炎病人随机行EST(治疗组)30例,不加干预(对照组)31例。结果两组病人的发热时间有显著区别[(3．2± 2．2)d vs(4．3±2．1)d,P<0．001],住院时间也有显著的区别。全部病人的随访时间平均为(24．3 ±11．1)个月,共12例出现急性胆管炎复发,治疗组8例,对照组4例(P=0．17)。结论 EST可缩短无胆总管结石的急性胆管炎病人的发热时间和住院时间,但不能减少胆管炎的复发。 Objective To evaluate the efficacy of endoscopic papillary muscle excision (EST) in the treatment of acute cholangitis without common bile duct stones in a randomized controlled trial. Methods Thirty patients with acute cholangitis without choledocholithiasis and without obstruction of the tumor were randomly treated with EST (treatment group) and 31 without intervention (control group). Results There was a significant difference in fever time between the two groups ([3.2 ± 2.2] d vs (4.3 ± 2.1) d, P <0.001). There was also a significant difference in hospitalization time. All patients were followed up for an average of (24.3 ± 11.1) months, a total of 12 cases of acute cholangitis recurrence, the treatment group of 8 patients and the control group of 4 patients (P = 0.17). Conclusion EST can shorten the fever time and hospital stay in patients with cholangiolithiasis without acute cholangitis, but can not reduce the recurrence of cholangitis.