Ueno N, Ozawa Y
Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
J Gastroenterol Hepatol. 1999 Aug;14(8):822-6. doi: 10.1046/j.1440-1746.1999.01958.x.
Endoscopic sphincter dilation (ESD) is believed to successfully treat bile duct stones without serious procedure-related complications.
We evaluated the efficacy, safety and limitations of this relatively new procedure in a consecutive series of patients to establish the clinical role of this modality for treating bile duct stones. One hundred and forty-three consecutive patients were treated by ESD between July 1995 and March 1998. The balloons used were a Maxforce 5-Fr or Olbert 5-Fr balloon-tipped catheter with a maximal diameter of 8 mm. Mechanical lithotriptor (ML) or extracorporeal shock wave lithotripsy (ESWL) were used when stones were large and/or numerous and a Dormia basket or retrievable balloon catheter was used to extract the stones entirely. Procedure-related symptoms and chemical data after the procedure were monitored during and after ESD at least until the following morning. To diagnose residual stones accurately, intraductal ultrasonography was routinely used.
Although the majority of patients complained of subtle pain during balloon inflation and demonstrated oozing during and after balloon inflation, the procedures were well tolerated. Complete stone extraction was achieved in 139 (97.2%) of the patients. Mechanical lithotriptor and ESWL were used to assist stone clearance in 79 (55.2%) and 23 (16.1%) patients, respectively. Mild pancreatitis occurred in six patients (4.2%). However, there were no other serious complications. Stone recurrence was identified in six patients and these stones were re-extracted by subsequent ESD procedures.
A high success rate for stone extraction and the relative safety of this procedure was confirmed. However, there was recurrence in a relatively high percentage of patients within a short period and this may be a forthcoming issue in ESD. Long-term follow-up observation and the establishment of countermeasures for stone recurrence seem to be essential.
内镜括约肌扩张术（ESD）被认为能成功治疗胆管结石且无严重的手术相关并发症。
我们在一系列连续的患者中评估了这一相对较新的手术的疗效、安全性及局限性，以确定该方法在治疗胆管结石中的临床作用。1995年7月至1998年3月期间，连续143例患者接受了ESD治疗。使用的球囊为最大直径8mm的Maxforce 5F或Olbert 5F带导丝球囊导管。当结石较大和/或较多时，使用机械碎石器（ML）或体外冲击波碎石术（ESWL），并用Dormia网篮或可回收球囊导管将结石完全取出。在ESD期间及之后至少至次日早晨，监测手术相关症状及术后化学数据。为准确诊断残留结石，常规使用导管内超声检查。
尽管大多数患者在球囊扩张时主诉轻微疼痛，且在球囊扩张期间及之后有渗血，但手术耐受性良好。139例（97.2%）患者结石完全取出。分别有79例（55.2%）和23例（16.1%）患者使用机械碎石器和ESWL辅助结石清除。6例患者（4.2%）发生轻度胰腺炎。然而，无其他严重并发症。6例患者发现结石复发，这些结石通过后续的ESD手术再次取出。
证实了该手术结石取出成功率高且相对安全。然而，相当比例的患者在短时间内出现复发，这可能是ESD中一个即将出现的问题。长期随访观察及建立结石复发的应对措施似乎至关重要。
