Roberts-Thomson I C
Aust N Z J Med. 1984 Oct;14(5):611-7. doi: 10.1111/j.1445-5994.1984.tb05010.x.
Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978-1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p less than 0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high-risk patients with choledocholithiasis without cholecystectomy.
1978年至1983年期间，对300例患有胆道和/或胰腺疾病的患者实施了内镜括约肌切开术。最常见的适应证是胆囊切除术后胆总管结石（59%）、未行胆囊切除术的胆总管结石（17%）以及推测的Oddi括约肌运动障碍（15%）。在胆总管结石患者中，164例患者中有147例（90%）结石自行排出或从胆管中取出，其结局通过结石取出后立即进行的胆管造影或第二次逆行胆管造影确定。在推测的运动障碍患者中，只有51%的患者症状持续改善。并发症并不常见（5%），但包括切口边缘出血、胰腺炎、胆管炎和网篮嵌顿；无患者死亡。胆囊切除术后胆管结石患者十二指肠憩室更为常见（p<0.005）（28%），高于逆行胆管造影未发现结石的患者（9%），但憩室的存在并不影响手术结局。内镜括约肌切开术是一种安全有效的手术，对胆囊切除术后患有胆总管结石的老年患者以及未行胆囊切除术的高危胆总管结石患者尤为重要。
