Objective To exptore the efficacy of endoscopic therapy of periampullary duodenal diverlicula combined wilh common bile duel stones in the aged people. Methods From June 2006 to May 2011 45 aged people of periampullary duodenal diverlicula combined wilh common bile duel stones were analyzed. Toally 44 palienls underwent endoscopic sphinclerotomy(EST) or combined wilh baltoon dilalalion, endoscopic lilholripsy baskel or/(and) mechanical lilholripsy to remove the common bile duel stones. Results The diagnosis of common bile duel stones was conformed during the successful operalion in all the cases successfully. Diameler of stones between 0. 6 cm and 3. 0 cm, 27 palienls had one stone, 12 had Iwo and 6 had three or more. The stones were removed using baskel direclly in 34 palienls, 7 palienls were selected wilh Endoscopic mechanical lilholripsy(EML) , and plaslic slenl placement without calculus removal in 3 palienls. EST failed in one patient because of small duodenal papilla and huge stone. The stones were removed completely al the first opralion in 34 cases, and the other 6 cases received a second operalion after endoscopic nasobiliary drainage. Errhysis occurred in 3 patients during opralion and was healed by tocally sprinkling noradrenaline or electric coagulation. One patient had hemorrhage from the incision on the duodenal papilla 24 hours after the operalion and was cured by using clipper. 2 patients devetoped mild pancreatitis, 5 patients had a transient increase of serum amylase. They were cured by some medical methods. Thirly-six of the patients were foltowed up for 6 to 12 months, when common bile duct stones didn't reocccur. The stones became smaller in 3 palienls wilh plaslic slent and received endoscopic therapy again. Conclusion In the aged people, endoscopic therapy of periampullary duodenal diverticula combined wilh common bile duct stones is relalivly safe. Proper cut should be choose according to the tocation of diverlicula, the size of the stones, use for baltoon dilalalion and endoscopic mechanical lilholripsy(EML) etc, which can prevent the complications.%目的 探讨内镜治疗老年人十二指肠乳头旁憩室合并胆总管结石的疗效.方法 回顾性分析2006年6月-2011年5月45例老年人十二指肠乳头旁憩室合并胆总管结石的内镜治疗临床资料.对44例老年患者行内镜下十二指肠乳头括约肌切开术(EST)和(或)气囊扩张术,并行网篮取石或机械碎石后网篮取石.结果 所有病例插管造影成功均显示胆总管结石,结石直径在0.6~3.0 cm.其中单发结石27例,2枚结石12例,三枚以上6例.网篮直接取石34例,碎石后取石7例,3例胆总管放置塑料支架,1例因乳头太小无法行切开同时结石较大转手术治疗.一次取尽结石35例,放置鼻胆管引流后二次取石6例.3例术中乳头肌切开渗血,给予电凝、局部喷洒去甲肾上腺素或气囊压迫出血停止,1例24 h后乳头切口涌血,给予钛铗止血.2例出现术后轻症胰腺炎,5例出现一过性高淀粉酶血症,给予相应处理痊愈.对其中36例随访6~12个月未见结石复发,3例放置塑料支架患者半年后结石明显变小,再次内镜治疗.结论 老年十二指肠乳头旁憩室合并胆总管结石的内镜治疗是相对安全有效,内镜治疗应根据憩室位置和结石大小选择合适的乳头切开长度,结合气囊扩张、碎石等方法,可避免并发症发生.
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