Mac Mathuna P, White P, Clarke E, Lennon J, Crowe J
Gastrointestinal Unit, Mater Misericordiae Hospital, University College Dublin, Ireland.
Gut. 1994 Jan;35(1):127-9. doi: 10.1136/gut.35.1.127.
Removal of bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) usually includes papillotomy. Papillotomy is associated with occasional complications and in addition, the longterm sequelae of papillotomy in young patients having laparoscopic cholecystectomy remain unclear. As an alternative to papillotomy, this study prospectively evaluated the efficacy and safety of endoscopic balloon sphincteroplasty to facilitate bile duct clearance. Of 32 patients with bile duct stones (diameter 3-30 mm) at ERCP, sphincteroplasty was considered inappropriate in four patients because of stone size (> 20 mm) necessitating papillotomy for bile duct clearance. Sphincteroplasty was performed in the remaining 28 patients to permit duct clearance by dormier basket, balloon or mechanical lithotripsy. The bile duct was cleared in 22 patients (79%) while additional measures including papillotomy or stent insertion were required in the remaining six patients (21%) because of stone size or technical difficulties. There was no associated papillary haemorrhage. Pancreatitis was seen in one patient (4%) but resolved within 24 hours. Our preliminary experience suggests that sphincteroplasty is a safe and effective sphincter preservation technique that significantly reduces the necessity for papillotomy in the management of bile duct stones.
在内镜逆行胰胆管造影术（ERCP）期间去除胆管结石通常包括乳头切开术。乳头切开术偶尔会伴有并发症，此外，接受腹腔镜胆囊切除术的年轻患者进行乳头切开术的长期后遗症尚不清楚。作为乳头切开术的替代方法，本研究前瞻性评估了内镜下球囊括约肌成形术促进胆管结石清除的有效性和安全性。在32例ERCP检查发现胆管结石（直径3 - 30毫米）的患者中，有4例患者因结石尺寸过大（> 20毫米）而被认为不适合进行括约肌成形术，需要进行乳头切开术以清除胆管结石。其余28例患者接受了括约肌成形术，以便通过网篮、球囊或机械碎石术清除胆管结石。22例患者（79%）的胆管结石被清除，其余6例患者（21%）由于结石尺寸或技术困难，需要采取包括乳头切开术或置入支架等额外措施。未出现相关的乳头出血情况。1例患者（4%）出现胰腺炎，但在24小时内缓解。我们的初步经验表明，括约肌成形术是一种安全有效的保留括约肌技术，可显著减少胆管结石治疗中乳头切开术的必要性。
