Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Dig Endosc. 2010 Jul;22 Suppl 1:S98-S102. doi: 10.1111/j.1443-1661.2010.00955.x.
Extraction of large bile duct stones in patients who have undergone a Billroth II (B-II) gastrectomy can be challenging. Recently, a large balloon dilation performed after endoscopic sphincterotomy (ESLBD) was useful for the removal of large bile duct stones. The aim of our study was to evaluate the feasibility and safety of ESLBD for removal of bile duct stones in patients who have undergone a B-II gastrectomy. ESLBD for removal of bile duct stones were performed in 11 patients with a B-II gastrectomy at Tokyo Medical University Hospital. Immediately after EST, a large balloon catheter (maximum diameter 15 mm, 18 mm, or 20 mm) was passed over the guide-wire and positioned across the main duodenal papilla. Maximum stone size (short diameter) ranged from 7 to 30 mm with a median of 13.5 mm. The number of stones was 1-26 with a median of 4.8. The common bile duct diameter was 10 mm to 30 mm with a median of 18.1 mm. A mechanical lithotripter for crushing stones was used in two patients (18%). Papillary balloon dilation using variously sized balloons was performed in addition to endoscopic sphincterotomy. Complete clearance of bile duct stones was achieved in all cases at one session. There were no procedure-related adverse events such as acute pancreatitis or retroperitoneal perforation. ESLBD appears to be an effective and safe treatment for removal of difficult bile duct stones in patients who have undergone a B-II gastrectomy.
在接受毕罗氏 II 式（B-II）胃切除术后的患者中，取出大的胆管结石可能具有挑战性。最近，在进行内镜下括约肌切开术（ESLBD）后进行的大球囊扩张对于去除大的胆管结石是有用的。我们的研究目的是评估 ESLBD 在 B-II 胃切除术后患者中用于去除胆管结石的可行性和安全性。在东京医科大学医院，对 11 例接受 B-II 胃切除术的患者进行了 ESLBD 以去除胆管结石。在 EST 后立即，将大球囊导管（最大直径为 15mm、18mm 或 20mm）通过导丝传递并放置在主十二指肠乳头的对面。最大结石大小（短直径）范围为 7 至 30mm，中位数为 13.5mm。结石数量为 1-26 个，中位数为 4.8 个。胆总管直径为 10mm 至 30mm，中位数为 18.1mm。两名患者（18%）使用了机械碎石器来破碎结石。除了内镜下括约肌切开术外，还进行了不同大小球囊的乳头球囊扩张。所有病例均在一次治疗中成功清除胆管结石。没有与治疗相关的不良事件，如急性胰腺炎或腹膜后穿孔。ESLBD 似乎是一种有效且安全的治疗方法，可用于去除 B-II 胃切除术后患者中难以取出的胆管结石。
