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目的 探讨内镜下取石气囊扩张 (EBD)治疗胆总管结石的可能性、有效性及安全性。方法 对 4 7例胆总管结石患者进行了内镜下以取石气囊扩张Oddi括约肌及用气囊、网篮及机械碎石等方法取石治疗。为预防并发胰腺炎 ,术后酌情应用了善得定、鼻胆管引流及十二指肠乳头小切开等措施。结果 本组患者EBD治疗胆总管结石的成功率为 91 5 % ( 4 3 / 4 7)。一次EBD治疗后 4 1例 ( 87 2 % )结石全部取出 ,有 2例 ( 4 3 % )患者经第 2次EBD治疗后将结石全部取出 ,避免了内镜下乳头括约肌切开 (EST)。 4 7例患者中 2 7例 ( 5 7 4 % )结石直径大于 1 0cm ,施行了机械碎石术。 4例 ( 8 5 % )患者因结石太大 (≥ 2 0cm ) ,EBD治疗未成功 ,改行EST取出结石。本组患者无穿孔及出血并发症。 11例 ( 2 3 4 % )术后血清淀粉酶一过性升高 ,其中只有 1例伴有腹痛 ,经内科保守治疗迅速缓解。结论 EBD治疗胆总管结石可行、有效、安全。
Objective To investigate the possibility, effectiveness and safety of endoscopic balloon lithotripsy (EBD) in the treatment of common bile duct stones. Methods Forty-seven patients with choledocholithiasis underwent endoscopic balloon dilatation of Oddi sphincter and balloon therapy with balloon, basket and mechanical gravel. In order to prevent complicated with pancreatitis, after surgery as appropriate, good set, nasobiliary drainage and small incision of duodenal papillae and other measures. Results The success rate of EBD in the treatment of common bile duct stones was 91 5% (4 3/47). After an EBD treatment, 41 (87.2%) stones were completely removed. Two patients (43%) were completely removed after the second EBD, avoiding endoscopic sphincterotomy (EST). Twenty-seven of 47 patients (57.4%) had calculus larger than 10 cm in diameter and underwent mechanical lithotripsy. In 4 patients (85%), stones were too large (≥20 cm) and EBD was unsuccessful. This group of patients without perforation and bleeding complications. Eleven patients (23.4%) had elevated serum amylase after surgery. Only 1 patient had abdominal pain, which was quickly relieved by conservative medical treatment. Conclusions EBD is a feasible, effective and safe method for choledocholithiasis.