【作者】 刘洋；

【导师】 张斌；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 胆总管结石是临床的常见病，多发病，可以分为原发于胆道的原发性结石和继发于胆囊的继发性结石，无论是原发性结石还是继发性结石都可以引起包括急性梗阻性化脓性胆管炎、胆源性肝脓肿、胆源性胰腺炎、阻塞性黄疸等多种严重并发症，以往治疗主要以外科手术为主，虽然近30年来微创外科飞速的发展，使得腹腔镜下切除胆囊逐渐成为治疗胆囊结石的首选治疗方案，但是胆总管结石的治疗仍然困扰着人们，当内镜下十二指肠乳头括约肌切开术（EST）、十二指肠乳头柱状气囊扩张术（EPBD）等技术的出现后，为胆总管结石的微创治疗带来了曙光。但是十二指肠乳头括约肌切开术（EST）存在着容易出现肠穿孔、出血、胰腺炎、胆管炎等近期并发症，以及因为少数病例破坏了十二指肠乳头括约肌功能导致的反复的胆道感染。同样十二指肠乳头柱状气囊扩张术（EPBD）也有术后胰腺炎发病率高，对于可取出结石大小限制严格等缺点，故而，我们尝试应用十二指肠乳头括约肌的小切开联合十二指肠乳头柱状大气囊的扩张，期望在两种取石技术中找到平衡点，既最大程度的保留十二指肠乳头括约肌的功能，同时扩大可以取出结石大小的范围，减少术后近期及远期并发症的发生。更多还原

【Abstract】 The common bile duct stones clinical common disease, EST, EPBD.Technology to achieve the aspirations of the minimally invasive treatmentof common bile duct stones, but is also accompanied by intestinalperforation, bleeding, postoperative pancreatitis, cholangitis, and otherrecent concurrentdisease and recurrent cholangitis, the risk ofcholangiocarcinoma increased risk of long-term complications. In thisstudy, the nipple sphincter small incision joint nipple balloon dilatationfor the treatment of common bile duct stones.ObjectiveThis study investigated the efficacy of application of nipplesphincter small incision joint papillary large balloon dilatation treatmentof common bile duct stones.MethodsResultsEST group and EST+EPLBD group were57cases (95%) and58cases (96.6%) successfully take the net stones, which have55cases(91.6%) and56cases (93.3%) for a complete, mechanical lithotripsyapplicationrates were9(22.5%) and17(42.5%). The overall incidence of hyperamylasemia, pancreatitis, bleeding, perforation and othercomplications after surgery were10%and6.6%, with no deaths.ConclusionEndoscopic papilla sphincter joint EPBD small incision surgery,reach and EST the same stone effect and compensate for the deficienciesof the EPBD, reduce the incidence of pancreatitis was significantly lowercompared to the pure EST bleeding risk, and, as far as possible, toretainduodenal papilla sphincter function, this approach combines theadvantages of EST and EPBD, in terms of efficacy, safety and reducecomplications, and achieved good results, easy to spread.更多还原