Summerfield J A, Hunt R H, Lister A H, Kirk A P
Br J Radiol. 1980 Nov;53(635):1041-6. doi: 10.1259/0007-1285-53-635-1041.
This paper reports the results of endoscopic sphincterotomy for bile duct stones in 50 patients. A design for a spincterotomy handle and a suitable stainless steel diathermy wire are described. Sphincterotomy was achieved in 45 patients (90%) and complete stone clearance in 42 (84%); this usually required two endoscopic examinations. Complications occurred in nine patients. Haemorrhage and pancreatitis were the most serious resulting in one laparotomy (haemorrhage) and one death (pancreatitis). Periampullary diverticula in 11 patients (22%) did not influence the success rate or the frequency of complications. A "pre-cut" in 11 patients (22%) permitted a later successful sphincterotomy in eight. Stone size (up to 3.5 cm) did not appear to influence outcome, but complete stone clearance was only achieved in two out of eight with more than ten bile duct calculi. Symptoms have not recurred up to three years after sphincterotomy. The data indicate that endoscopic sphincterotomy is of major value in high-risk patients with bile duct calculi and is also appropriate for most low-risk patients with retained stones after cholecystectomy.
本文报告了50例胆管结石患者内镜下括约肌切开术的结果。描述了一种括约肌切开术手柄的设计以及一种合适的不锈钢透热丝。45例患者（90%）成功进行了括约肌切开术，42例（84%）结石完全清除；这通常需要两次内镜检查。9例患者出现并发症。出血和胰腺炎最为严重，分别导致1例剖腹手术（出血）和1例死亡（胰腺炎）。11例患者（22%）存在壶腹周围憩室，这对成功率或并发症发生率没有影响。11例患者（22%）进行了“预切开”，其中8例随后成功进行了括约肌切开术。结石大小（最大3.5 cm）似乎不影响手术结果，但8例有十多个胆管结石的患者中只有2例结石完全清除。括约肌切开术后长达三年症状未复发。数据表明，内镜下括约肌切开术对高危胆管结石患者具有重要价值，对大多数胆囊切除术后有残留结石的低危患者也适用。
