关键词: 内镜逆行胰胆管造影术, 塑料支架, 胆总管结石

Abstract: 【Abstract】 Objective To investigate the clinical efficacy and safety of stage-wise treatment with small-incision endoscopic sphincterotomy plus plastic biliary stenting on large or multiple common bile duct stones. Methods A total of 72 Patients were recruited and treated by ERCP with large（≥20 mm）or multiple（≥3）CBD stones from January 2010 to December 2015. The patients were assign to observation group （n=36） and control group （n=36）, and the former were treated with small-incision endoscopic sphincterotomy and placement of plastic stents in the bile duct without stone extraction at the initial ERCP, then a month later, the second ERCP was carried out and stone removal was attempted. The patients in control group were performed with small-incision endoscopic sphincterotomy, stone removal and nasobiliary drainage in one stage ERCP. The stone clearance, post-ERCP pancreatitis（PEP）, severe post-ERCP pancreatitis, bleeding and biliary tract infection were compared between two groups. ResultsThe total stone clearance at second ERCP was 94.4% in observation group and the total stone clearance was 91.2% in control group. The post-ERCP complications in observation group included one case of PEP and one case of postoperative hemorrhage. However, 8 cases of PEP（22.2%）, 6 cases of postoperative hemorrhage （16.7%） were recorded in control group （all P values less than 0.05, as compared with observation）. No biliary tract infection were occurred in observation group, when compared with five cases biliary tract infection（13.9%）in control group. Conclusion Stage-wise treatment of large or multiple common bile duct stones through small-incision endoscopic sphincterotomy and plastic biliary stenting is a safe, effective and feasible method.

Key words: Plastic biliary stent, Endoscopic retrograde cholangiopancreatography , Common bile duct stone