Ersoz Galip, Tekesin Oktay, Ozutemiz Ahmet Omer, Gunsar Fulya
Ege University School of Medicine, Department of Gastroenterology, Izmir, Turkey.
Gastrointest Endosc. 2003 Feb;57(2):156-9. doi: 10.1067/mge.2003.52.
Bile duct stones are still present in 10% to 15% of patients after the application of conventional endoscopic extraction techniques and require additional procedures for duct clearance. In the vast majority of these cases, there are 2 main problems: large stone size (>15 mm) and tapering of distal bile duct.
Fifty-eight patients in whom endoscopic sphincterotomy and standard basket/balloon extraction were unsuccessful in the removal of bile duct stones underwent dilation with a 10- to 20-mm diameter (esophageal/pyloric type) balloon at the same session. In 18 patients with tapered distal bile ducts (Group 1), 12- to 18-mm diameter balloon catheters were used to enlarge the orifice. In 40 patients with square, barrel shaped and/or large (>15mm) stones (Group 2), the sphincterotomy orifice was enlarged with 15- to 20-mm diameter balloon catheters. After dilatation, standard basket/balloon extraction techniques were used to remove the stone(s).
Stone clearance was successful in 16 patients (89%) in Group 1 and 35 (95%) in Group 2. Complications occurred in 9 (15.5%) patients.
Dilation with a large-diameter balloon after endoscopic sphincterotomy is a useful alternative technique in patients with bile duct stones that are difficult to remove with standard methods.
在应用传统内镜取石技术后，仍有10%至15%的患者存在胆管结石，需要额外的操作来清除胆管结石。在这些病例的绝大多数中，存在两个主要问题：结石尺寸较大（>15毫米）和远端胆管逐渐变细。
58例经内镜括约肌切开术和标准网篮/球囊取石术未能成功取出胆管结石的患者，在同一次手术中使用直径为10至20毫米（食管/幽门型）的球囊进行扩张。在18例远端胆管逐渐变细的患者（第1组）中，使用直径为12至18毫米的球囊导管扩大开口。在40例结石呈方形、桶状和/或较大（>15毫米）的患者（第2组）中，使用直径为15至20毫米的球囊导管扩大括约肌切开术开口。扩张后，采用标准网篮/球囊取石技术取出结石。
第1组16例患者（89%）结石清除成功，第2组35例患者（95%）结石清除成功。9例（占15.5%）患者出现并发症。
对于用标准方法难以取出的胆管结石患者，内镜括约肌切开术后用大直径球囊扩张是一种有用的替代技术。
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