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

摘要： 【摘要】目的探讨经内镜逆行胰胆管造影术（ERCP）Ⅰ期先行乳头括约肌小口切开并放置塑料支架解除梗阻，一月后再Ⅱ期取石，分期治疗巨大或多发胆总管结石的临床应用的安全性及有效性。方法回顾性分析2010年1月至2015年12月在我科住院首次行ERCP治疗的72例直径≥20mm或结石数量≥3粒的胆总管结石患者，分为观察组（一期ERCP放置支架，1月后二期取石，n=36）；对照组（一期治疗组，n=36）。观察和比较两组病例术后结石清除率，ERCP后胰腺炎（PEP）、重症胰腺炎发生，术后出血、胆道感染发生情况。结果在术后结石清除率方面观察组34例（94.4%）与对照组31例（91.2%），比较差异无统计学意义（P>0.05）；观察组ERCP术后胰腺炎1例，对照组有8例（P<0.05）；观察组无重症胰腺炎发生，对照组发生2例；观察组1例发生术后出血，对照组则有6例发生（P<0.05）；观察组没有发生术后胆道感染，对照组发生5例（P<0.05）。结论内镜下乳头括约肌小切开并放置塑料支架分期取石术治疗巨大或多发胆总管结石是安全、有效、可行的。

关键词: 内镜逆行胰胆管造影术, 塑料支架, 胆总管结石