目的 探讨内镜乳头括约肌切开术(EST)对十二指肠乳头旁憩室合并胆总管结石治疗的方法及价值.方法 我院2005年1月至2009年4月282例EST病例,其中38例为十二指肠乳头旁憩室合并胆总管结石患者,回顾性分析十二指肠憩室对这些病例的ERCP成功率、EST及其并发症的影响.结果 该组38例十二指肠乳头旁憩室合并胆总管结石患者,占所发现十二指肠乳头旁憩室的52.1%(38/73).ERCP造影成功率94.7%(36/38),36例患者中33例(91.7%)成功施行EST取石.3例EST失败,1例因结石太大网篮圈套困难,1例因结石多患者高龄未做乳头括约肌切开直接置入内支架,另1例因十二指肠乳头切开出血转外科手术治疗.该组EST术中创口出血者5例,其中4例均经局部内镜止血成功,术中及术后无十二指肠穿孔、急性胰腺炎等严重并发症发生,无死亡病例.结论 胆道结石发生率与十二指肠乳头旁憩室发生有关.十二指肠乳头旁憩室对ERCP及EST治疗胆管结石有一定影响,只要术者操作小心、细致,十二指肠乳头旁憩室合并胆管结石经内镜下取石仍是一种相对安全、有效的治疗手段.%Objective To investigate the curative methods and value of the endoscopic therapy for periampullary diverticula combined with common bile duct stones. Methods Two hundred and eighty two consecutive patients undergoing endoscopic sphincterotomy were prospectively enrolled in our hospital from January 2005 to April 2009. Thirty-eight patients of them were periampullary diverticula combined with common bile duct stones. The influence of duodenal diverticulum on success rate of KRCP, KST and complications were retrospectively analyzed. Results Periampullary diverticula was present in seventy three patients underwent ERCP, of which 52. 1 % (38/73) were complicated with calculus of bile duct, success rate of KRCP was 94. 7%(36/38) , and the stones were removed successfully by EST in 33 of 36 patients(91. 7%). EST failed in three patients, one patient of huge bile duct stones. An old patient was performed endoscopic biliary stents without sphincterotomy for large stones. One patient of mild bleeding seeked help of surgical operation. Four of the patients with slight hemorrhage after EST and had been hemostasis by endoscopic injection immediately, there were no serious complications including perforation, acute pancreatitis and death happened after treatment. Conclusion The periampullary diverticula is prone to be complicated with calculus of bile duct, which makes ERCP and EST a little more difficult and risky. However, as long as the operator is patient and cautious, therapeutic ERCP and EST can be safely and effectively performed.
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