Abstract:

 Objective To investigate the clinical value of combination of limited endoscopic sphincterotomy （limited EST） and endoscopic retrograde bilioduodenal drainage （ERBD） in the treat-ment of refractory common bile duct stones. Methods Forty-eight cases with common bile duct stones were assigned to observation group （n=25）in which the patients were performed limited EST + ERBD, and control group（n=23）, the patients underwent ERBD alone. All the 48 patients were treated with 8.5 Fr biliary plastic stent drainage. The degree of abdominal pain, fever, white blood cells, amylase, lipase and other related index were observed at one week after operation were recorded. Liver function-related indicators and the condition of common bile duct stones were observed at one, three and six months after operation. The safety and effectiveness of limited EST+ERBD were evaluated. Results The treatment both limited EST plus ERBD and ERBD alone gained a significant effect on symptom relief. None of bleeding, perforation and other serious complications occurred in follow-up. The Results both group at 1 month and 3 months after operation were similar （all P values less than 0.05）in recorded indexes. However, the observation group had better outcomes after 6 months. Conclusion Limited EST + ERBD is a safe and effective transition therapy for refractory common bile duct stones, and it will win time for the next treatment.

Key words: common bile duct stones, endoscopic retrograde bilioduodenal drainage, endoscopic sphincterotomy

摘要：

目的 探讨内镜下十二指肠乳头小切开（limitedendoscopicsphincterotomy，limitedEST）+胆道塑料支架内引流（endoscopicretrogradebilioduodenaldrainage，ERBD）治疗难取性胆总管结石的临床价值。方法 常规方法行ERCP，观察组25例行乳头小切开，对照组23例非切开，在导丝引导下置入8.5Fr胆道塑料支架内引流治疗，观察术后1周的腹痛程度、发热、血白细胞、淀粉酶、脂肪酶等相关指标，以及1、3、6月肝功能指标、结石情况，评价小EST+ERBD的安全性及有效性。结果 两组对于症状缓解均有明显效果，无出现出血、穿孔等严重并发症，1、3月的结果相似，无统计学差异，6月后观察组有优势。结论 对于难取性胆总管结石，小EST+ERBD不失为一种简单、安全而有效的过渡治疗方法，为二次处理赢得时间。

关键词: 胆道支架内引流, 胆总管结石, 内镜下十二指肠乳头切开