十二指肠乳头部结石嵌顿内镜下治疗的回顾性研究

Therapeutic endoscopy for stones incarceration at the duodenal papilla： a retrospective study

摘要:

目的 研究乳头部结石嵌顿病例特点和内镜治疗效果，探讨针状刀切开在治疗嵌顿结石中的有效性。 方法 收集2007年至2016年316例乳头部结石嵌顿病例资料。观察内镜治疗结果及操作方法，分析年嵌顿结石占同期全部胆管结石百分比变化趋势及胆管直径和嵌顿结石直径的变化趋势。 结果 316例患者均在内镜下成功解除梗阻并置鼻胆管引流（100.0％），其中231例（73.1％）需采用针状刀切开。按年分层显示，十二指肠乳头部结石嵌顿者占同期全部胆管结石百分比呈减少趋势（P=0.000）。胆总管直径（P=0.000）及嵌顿结石直径（P=0.000）均呈减小趋势。 结论 近年来十二指肠乳头部结石嵌顿有减少趋势，胆总管直径和嵌顿结石直径存在逐渐减小的变化趋势。针状刀括约肌切开是处理乳头部嵌顿结石的主要方式。

Abstract:

Objective To investigate the clinical characteristics of incarcerated stones at duodenal papilla and to evaluate the efficacy of endoscopic needle-knife sphincterotomy（NKS）. Methods Data of 316 patients who underwent endoscopic treatment for incarcerated stones at duodenal papilla between 2007 and 2016 were retrospectively studied. Endoscopic treatment outcomes， proportion changes of incarcerated stones in total number of choledocholithiasis， changes of diameter of common bile duct（CBD） and diameter of incarcerated stones were analyzed. Results Obstruction was relieved and endoscopic nasobiliary drainage was successfully performed in all 316 cases （100.0％）， and NKS procedures were performed in 231 patients （73.1％）. The incidence of incarcerated stone at duodenal papilla in choledocholithiasis showed a decreased trend （P=0.000）. Diameters of both CBD and incarcerated stones showed a decreased trend in hierarchical data by year （P=0.000， P=0.000）. Conclusion The incidence of incarcerated stones at duodenal papilla in choledocholithiasis， the diameters of CBD and incarcerated stones are all on the decrease. NKS is the primary method for treatment of incarcerated stones at duodenal papilla.