Sugawa C, Wiencek R G
Department of Surgery, Wayne State University, Detroit, Michigan 48202.
Am Surg. 1988 Jul;54(7):412-8.
Endoscopic retrograde sphincterotomy (E.R.S.) is rapidly becoming popular. In the past 5 years, E.R.S. was technically successful in 124 of 130 patients (95%) in whom it was attempted. One hundred twenty four had choledocholithiasis, and six had papillary stenosis after cholecystectomy. Urgent E.R.S. was performed for septic cholangitis in 12 patients and biliary pancreatitis in four. There were six patients with choledocholithiasis in whom sphincterotomy was not possible. Of the 118 patients with successful papillotomy for choledocholithiasis, spontaneous passage of calculi after E.R.S. occurred in 28 cases (24%), and instrumental extraction of stones was possible in 81 (69%). Duct clearance failed in nine patients (8%), mostly due to the large size of the retained stones. The largest stone extracted was 26 mm in diameter. The overall success rate of removing common bile duct stones was 109 in 118 cases (88%). In patients with papillary stenosis, E.R.S. was successful in relieving symptoms and biochemical cholestasis in six of six cases (100%). Complications occurred in only two patients. The complications were pancreatitis in one and hemorrhage in one. None of these patients required surgical treatment of the complication. Endoscopic retrograde sphincterotomy is effective for the removal of stones of the common bile duct, and at relieving the symptoms of papillary stenosis. It is safe in experienced hands and has led to only rare complications.
内镜逆行括约肌切开术（E.R.S.）正迅速流行起来。在过去5年中，130例尝试进行E.R.S.的患者中有124例（95%）在技术上获得成功。其中124例患有胆总管结石，6例在胆囊切除术后出现乳头狭窄。12例因化脓性胆管炎和4例因胆源性胰腺炎进行了急诊E.R.S.。有6例胆总管结石患者无法进行括约肌切开术。在118例因胆总管结石成功进行乳头切开术的患者中，E.R.S.后结石自行排出的有28例（24%），通过器械取石成功的有81例（69%）。9例患者（8%）胆管清理失败，主要原因是残留结石体积较大。取出的最大结石直径为26毫米。118例中成功取出胆总管结石的总成功率为109例（88%）。在乳头狭窄患者中，6例中有6例（100%）E.R.S.成功缓解了症状和生化性胆汁淤积。仅2例患者出现并发症。并发症1例为胰腺炎，1例为出血。这些患者均无需对并发症进行手术治疗。内镜逆行括约肌切开术对于取出胆总管结石以及缓解乳头狭窄症状是有效的。在经验丰富的医生操作下是安全的，且仅导致罕见的并发症。
