Mathuna P M, White P, Clarke E, Merriman R, Lennon J R, Crowe J
Gastrointestinal Unit, Mater Misericordiae Hospital, University College Dublin, Ireland.
Gastrointest Endosc. 1995 Nov;42(5):468-74. doi: 10.1016/s0016-5107(95)70052-8.
Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon papillary dilation or sphincteroplasty as an alternative.
We report the outcome in a series of 100 patients in whom balloon sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30).
During one ERCP session using sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat sphincteroplasty. No clinical evidence of papillary stenosis was observed during follow-up.
Endoscopic balloon papillary dilation or sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
由于括约肌切开术占与内镜逆行胰胆管造影（ERCP）相关的发病率和死亡率的很大一部分，我们提出内镜球囊乳头扩张术或括约肌成形术作为替代方法。
我们报告了一系列100例患者的结果，这些患者尝试进行球囊括约肌成形术以治疗直径达20毫米的胆管结石，中位随访时间为16个月（范围6至30个月）。
在仅使用括约肌成形术的一次ERCP过程中，78%的胆管结石被清除，直径大于12毫米的结石有10%需要进行机械碎石术。另有4%的患者胆管清除不完全，所有这些患者均接受了重复ERCP，胆管清除成功，无需进行括约肌切开术。其余18%的患者未能通过括约肌成形术清除胆管，主要原因是结石较大（>15毫米）。7%的患者需要进行括约肌切开术以清除胆管。另外6%包括患有多个大于15毫米的大结石的老年高危患者，他们接受了支架置入加熊去氧胆酸治疗。未观察到乳头出血；5%的患者发生了无并发症的胰腺炎。在中位随访16个月期间，2%的患者出现复发性有症状胆管结石，这些结石被认为在初次ERCP后未被识别：在重复括约肌成形术后被清除。随访期间未观察到乳头狭窄的临床证据。
内镜球囊乳头扩张术或括约肌成形术是治疗小于12毫米胆管结石时括约肌切开术的一种安全有效的替代方法；较大的结石可能需要机械碎石术以促进胆管清除。
