摘要

当取石困难或被认为有危险时，建议在内镜下放置胆总管假体以处理胆总管结石。在两年多的时间里，这种方法被用于40例这样的患者。24名女性和16名男性，中位年龄为76岁。在7名严重胆管炎的患者中，没有尝试取出结石。23例(57.5%)患者行括约肌切开术，4例(10%)患者行针刀乳头切开术。13例(32.5%)患者认为置入假体是一种临时措施，27例(67.5%)患者认为是最终治疗。所有患者均建立胆管引流。6例患者(15%)出现早期并发症，但无后遗症。8例(20%)患者出现晚期并发症，包括胆绞痛(4例)、胆管炎(3例)和胆囊炎(1例)。两个病人(一个胆管炎和一个胆囊炎)死于并发症。 Only patients without a sphincterotomy developed cholangitis. A total of eight patients (20%) underwent surgery (one as an emergency) and nine a repeat endoscopic retrograde cholangio pancreatography (two as an emergency) to clear the duct. The remaining 23 patients are asymptomatic at a median of 13 months (range five to 24 months). Biliary endoprosthesis insertion for choledocholithiasis is an important alternative means of establishing drainage in selected cases, and is probably the optimum method of management for the elderly and or debilitated patients with previous cholecystectomy. Caution must be exercised, however, in patients with an in situ gall bladder.