乳头开窗联合大球囊扩张术治疗胆总管末端嵌顿巨大结石的临床应用

Clinical adhibition of duodenum nipple fistulation combined with endoscopic large-balloon dilation in treating incarcerated choledocholithiasis

摘要:

目的  评价经内镜乳头开窗联合大球囊扩张术取胆总管末端嵌顿巨大结石的疗效及安全性。 方法  回顾34例胆总管巨大结石（15 mm≤结石最大直径≤25 mm）嵌顿患者，经常规乳头插管或经乳头预切开插管均失败，应用乳头开窗联合大球囊扩张术治疗，总结患者临床资料，分析该方法的疗效及安全性。结果  34例胆总管巨大结石嵌顿患者均一次开窗成功，开窗成功后直接结石脱出8例（23.53%），大球囊扩张后网篮直接取出结石16例（47.06%），经碎石后取出结石8例（23.53%）。2例（5.88%）因结石较大且坚硬未取出，置入塑料支架引流4个月后再次行经内镜逆行性胰胆管造影术（ERCP），结石变小，碎石网篮成功取出结石。1例患者肠穿孔，保守治疗成功恢复，术后并发急性胰腺炎2例，均为轻度，保守治疗恢复。结论  胆总管末端嵌顿巨大结石常规治疗失败的患者，经乳头开窗联合大球囊扩张术取石成功率高，并发症少，安全可靠，值得进一步推广。

Abstract:

Abstract: Objective To evaluate the efficacy and safety of duodenum nipple fistulation combined with endoscopic large-balloon dilation in getting out the huge ithiasis (15 mm≤ diameter ≤ 25 mm) blocking in choledoch terminal. Method To review 34 patients with huge ithiasis blocking in choledoch terminal, which were could not be getting out by intubation tube through duodenotomy or with duodenotomy desection. But these ithiasis were getting out by duodenum nipple fistulation combined with endoscopic large-balloon dilation. Then evaluate the efficacy and safety of duodenum nipple fistulation combined with endoscopic large-balloon dilation by summarizing the patients' clinical data. Results Fistulation of 34 patients was successful once. Ithiasis was running out after fistulation for 8 (23.50 %) patients. 16 (47.10 %) patients should use the net to get the stone out, the stone should be smashed and got out for 8 patients (23.50 %). The stone in 2 patients was too big and hard to get out, we put the plastic trestle for drainage for 4 months and then we got out the stone by net. One patient had an intestinal perforation and recovered after medicine treatment. Low-grade pancreatitis occurred in 2 patients as a syndrome, and also recovered after medicine treatment. Conclusion Duodenum nipple fistulation combined with endoscopic large-balloon dilation was safe with less syndromes, and high success rate, it worth to be spread.