ENDOSCOPIC SPHINCTEROPLASTY - A NOVEL AND SAFE ALTERNATIVE TO PAPILLOTOMY IN THE MANAGEMENT OF BILE-DUCT STONES
ENDOSCOPIC SPHINCTEROPLASTY - A NOVEL AND SAFE ALTERNATIVE TO PAPILLOTOMY IN THE MANAGEMENT OF BILE-DUCT STONES
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DOI：
10.1136/gut.35.1.127
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发表时间：
1994-01-01
期刊：
影响因子：
24.5
通讯作者：
CROWE, J
中科院分区：
文献类型：
--
作者：
MACMATHUNA, P;WHITE, P;CROWE, J
在内镜逆行胰胆管造影术（ERCP）中清除胆管结石通常包括乳头切开术，乳头切开术与偶尔的并发症有关，此外，乳头切开术在接受腹腔镜胆囊切除术的年轻患者中的长期后遗症尚不清楚。作为乳头切开术的替代方法，本研究前瞻性评价了内镜球囊括约肌成形术促进胆管清除的有效性和安全性。在32例ERCP胆管结石（直径3 - 30 mm）患者中，4例患者因结石大小（> 20 mm）需要切开乳头清除胆管而认为括约肌成形术不合适。其余28例患者进行了脊柱成形术，以允许通过背篮、球囊或机械碎石术清除胆管。22例患者（79%）的胆管被清除，而其余6例患者（21%）由于结石大小或技术困难需要采取额外措施，包括乳头切开术或支架植入术。thc：re与乳头出血无关。1例患者（4%）出现胰腺炎，但在24小时内消退。我们的初步经验表明，括约肌成形术是一种安全有效的括约肌保留技术，可显著减少乳头切开术治疗胆管结石的必要性。
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. Spincteroplasty 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. Thc:re 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.