内镜下十二指肠乳头括约肌小切开联合大球囊扩张术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的远期疗效分析

Long-term efficacy analysis of limited endoscopic sphincterotomy with large balloon dilation and endoscopic duodenal papillary sphincterotomye for treatment of common bile duct stones

目的 比较内镜下十二指肠乳头括约肌小切开联合大球囊扩张术(ESLBD)(12~15 mm)与内镜下十二指肠乳头括约肌切开术(EST)治疗难治性胆总管结石的远期疗效。方法 选择2009年1月至2020年1月在上海交通大学医学院附属瑞金医院和上海中医药大学附属曙光医院消化内镜中心采用EST或ESLBD(12~15 mm)治疗的131例难治性胆总管结石患者,分为EST组(n=70)和ESLBD组(n=61),比较2组的完全取石成功率、经内镜逆行胰胆管造影术(ERCP)相关术后近期并发症及远期并发症发生率等指标。结果 EST组和ESLBD组的取石成功率和机械碎石率差异均无统计学意义(98.6%比100.0%,24.3%比18.0%,P均>0.05)。EST组的ERCP术后近期并发症发生率高于ESLBD组(8.6%比3.3%),但差异无统计学意义(P>0.05)。长期随访结果显示,EST组和ESLBD组的ERCP术后远期并发症发生率差异无统计学意义(11.9%比8.6%,P>0.05)。结论 与EST相比,ESLBD(12~15 mm)用于治疗难治性胆总管结石是安全有效的,尤其是对于合并十二指肠乳头旁憩室、凝血功能障碍等患者,ESLBD可作为首选治疗方法。EST与ESLBD的术后远期并发症发生率相似,ESLBD也会造成十二指肠乳头括约肌功能损伤。

Objective This paper aims to compare the long-term efficacy of limited endoscopic sphincterotomy with large balloon dilation(ESLBD)and endoscopic duodenal papillary sphincterotomye(EST)for the treatment of common bile duct stones.Methods A hundred and thirty-one patients with common bile duct stones treated with EST or ESLBD(12-15 mm)at the Digestive Endoscopy Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, and Shuguang Hospital, ShanghaiUniversity of Traditional Chinese Medicine from January 2009 to January 2020 were selected and assignedto the EST group (n=70) and the ESLBD group (n=61). The success rate of complete stone removal, andthe incidence of recent and long-term complications after endoscopic retrograde cholangiopancreatography(ERCP) were compared between the two groups. Results There is no statistically significant difference inthe success rate of stone extraction and mechanical fragmentation between the EST group and the ESLBDgroup (98.6% versus 100.0%, 24.3% versus 18.0%, and P>0.05). The incidence of recent complicationsafter ERCP in the EST group is higher than that in the ESLBD group (8.6% versus 3.3%), but the differenceis not statistically significant (P>0.05). The long-term follow-up results show that there is no statisticallysignificant difference in the incidence of long-term complications after ERCP between the EST group and theESLBD group (11.9% versus 8.6%, and P>0.05). Conclusions Compared with EST, ESLBD (12-15 mm)is a safe and effective treatment for common bile duct stones. Especially for special patients with concomitantduodenal papillary diverticulum and coagulation dysfunction, ESLBD can be the preferred treatment method.The incidence of long-term postoperative complications in EST and ESLBD is similar, and ESLBD can alsocause varying degrees of damage to the function of the duodenal papillary sphincter.