Objective To investigate the effectiveness and safety of endoscopic papillary large-balloon dilation(EPLBD) for juxtapapillary duodenal diverticulum(JPD)combined with large common bile duct stones.Methods A total of 87 patients with juxtapapillary duodenal diverticulum and large common bile duct stones were randomly divided to 2 groups.Forty-five cases received endoscopic papillary large-balloon dilation(EPLBD group) as the treatment group,and 42 cases were treated by conventional endoscopic sphincterotomy(EST group) as the control group.The success rate of stone clearance in a single session,operation time,the rate of mechanical lithotripsy and complications were observed.Results Stone clearance in a single session of 2 groups were 91.1％ (EPLBD group)and 92.9％ (EST group) respectively with no significant difference(P ＞ 0.05).The stone removal time were (25.48 ± 7.92) min in EPLBD group and(35.56 ± 9.23) min in EST group (P ＜ 0.05).The rate of mechanical lithotripsy were 16.3％ and 34.6％ in two groups with significant differences.Rates of bleeding,postoperrative pancreatitis and cholangitis in two groups were similar(P ＞ 0.05).No death happened in any group.Conclusion EPLBD is a safe and effective method for clearance of large common bile duct stones combined with juxtapapillary duodenal diverticulum which can reduce the occurrence of mechanically breaking stone and operation time.

经过老一辈内镜专家的努力推广,胆管结石患者的ERCP取石术已经得到广泛开展,技术已较成熟.但对于取石前乳头的处理,应用乳头括约肌切开术(EST)或应用乳头柱状气囊扩张术(EPBD)仍有较大争议.目前大多数医生倾向于应用EST[1].因为施术医生EST水平、乳头切开大小、凝切电流频率及指数不同,所以EST术后并发症的发生率差异较大.为避免EST造成乳头括约肌功能永久性破坏,Staritzu等[2]尝试使用小直径的柱状气囊扩张乳头而获成功.国内也逐渐开展EPBD术,疗效满意[3].近年来美国学者使用大直径(12～20 mm)的乳头柱状气囊扩张治疗胆总管巨大结石亦获成功,术后并发症的发生率较低[4]。