中文摘要：

目的：目前认为，十二指肠胆道反流是引起胆道反复感染，进而导致胆道结石再发和胆道狭窄的原因之一。近年来应用以内镜下逆行胆胰管造影术（endoscopicretrogradecholangiopancreatography，ERCP）为基础的微创治疗胆总管结束的技术开展颇为广泛。它主要包括ERCP、Oddi括约肌切开术（endoscopicsphincterotomy，EST）、十二指肠乳头球囊扩张术（endoscopicpapillarybal—Iondilation，EPBD）、胆管结石碎石取石术、胆总管支架植入术和鼻胆管引流术六大技术。本文主要研究了采用不同术式的EST，即EST中切口和EST小切口＋EPBD术，在术后早期对患者十二指肠胆道反流的影响。方法：63例胆总管结石患者，男30例，女33例，予行经内镜下逆行的胆胰管造影（ERCP）后分别采用不同术式EST，术后安放胆总管引流管。术后l周留取胆汁采用口服核素和测定胆汁中的胃蛋白酶I、II的浓度，对十二指肠胆道反流进行定量和定性的测定。结果：EST中切口术组、EST小切口＋球囊扩张（EPBD）组分别与无EST组相比，年龄和性别无统计学意义（P=0．07，P=0．416）。行EST中切开和小切开＋球囊扩张患者胆汁中的锝计数明显高于无EST组，且这两组不同术式的患者锝计数存在显著的统计学差异（P〈0．05）。行EST中切口者、EST小切口＋球囊扩张术者胆汁中的PGII质量浓度明显低于无EST组（P〈0．05），但是EST中切口者和EST小切口＋球囊扩张术后两组间胆汁中PGII的质量浓度无统计学差异。结论：行EST中切口取胆总管结石的患者在手术早期较易发生十二指肠胆道的反流。因此，建议对于胆总管结石患者尽量选择行EST小切口＋球裳扩张术（EPBD）的手术方式。

英文摘要：

Objective： Nowadays dudodenal-intestinal reflux is one of the causes in recurrence of biliary infection and biliary stenosis. As the basis ofmini-invasive technique, endoscopic retrograde cholangiopancreatography （ERCP） is widely applied in treating common bile stone. It included ERCP, endoscopic sphincterotomy （EST）, endoscopic papillary ballon dilation （EPBD）, bile duct stone lithotripsy, stent plantation of common bile duct and nasobiliary drainage.This article studied the effect on duodenal-biliary reflux by dif- ferent EST which included middle-incision EST and minor-incision EST enrolled in this study. Male patients were 30 and female patients were 33. ＋ EPBD. Method： 63 patients with commom bile stones were They underwent endoscopic retrograde cholangiopancreatogra- phy （ERCP） followed by middle-incision EST or minor-incision EST＋ endoscopic papillary balloon dilation （EPBD） operation. The drainage tube of common bile duct was placed after ERCP. 1 week after operation, bile was collected from the drainage tube of common bile duct. Pepsinogen I and pepsinogen II in bile collected from drainage tube of common bile duct were measured by enzyme linked immunosorbent assay （ELISA） for qualitative analysis ofduodenal-biliary reflux. Patients also took orally 185MBq of 99mTc-DTPA and 99mTc-DTPA radioactivity in the bile was counted for quantitative analysis of duodenal-biliary reflux. Result： It is no statistically signifi- cant in gentle and ages in middle-incision EST and minor-incision EST ＋ endoscopic papillary balloon dilation （EPBD） compared with negative controlled group （P =0.07, P~0.416 ）. The radioactivities in the bile are higher in EST middle-incision groups and EST minor-in- cision ＋ EPBD groups than in negative controlled group. It is statistically significant in radioactivities between EST middle-incision and EST minor-incision ＋EPBD group （P〈0.05）. The concentrations ofpepsinogen II in EST middle-incision groups and EST minor-inci- sion ＋ EPBD