改良内镜下乳头气囊扩张术应用的可行性研究

Study on the feasibility of modified endoscopic papillary balloon dilatation technology

目的探讨改良内镜下乳头气囊扩张术(EPBD)治疗胆管结石的可行性。方法对226例肝外胆管结石的患者应用肠道型柱状气囊行乳头扩张并在此基础上展开治疗,并比较2299例内镜乳头切开术(EST)的治疗效果及术后并发症情况。结果226例患者均顺利完成取石或碎石取石术,术后无胆道感染、穿孔等并发症,发生轻型急性胰腺炎4．7％(10例),与EST(5．2％)比较,差异无统计学意义,术后消化道出血0．47％(1例),与EST(1．2％)比较,差异有统计学意义。结论对EST困难或易发生并发症者用肠道型柱状气囊行EPBD术,能有效地钝性切割乳头,并在此基础上展开较大结石的取石或碎石取石术,同时并发症明显减少。EPBD是内镜下处理胆管结石安全有效的方法之一。

Objective To study on the feasibility of modified endoscopic papillary balloon dilatation （EPBD） technology in treating patients with common bile duct stone. Methods EPBD and appropriate treatment were conducted in 226 patients with common bile duct stones. By the results of EST in 2299 cases therapeutic effects and pest-operative complications were monitored and compared. Results Compared with EST, it is easier to perform stone extraction or stone destruction/extraction by using EPBD, the post-operative complications such as infection, and perforation were not occurred but mild acute pancreatitis happened in EPBD and EST group were 4. 7% （ 10 cases） and 5. 2% respectively without statistical significant difference, the post operative gastrointestinal haemorrhage in EPBD and EST were 0. 47% （ 1 cases） and 1.2% respectively with statistical significant difference. Conclusion In patients who are difficult to conduct EST or with high risk of complications, EPDB can afford effective papillary incision and stone destruction/extraction, and fewer post-operative complications. Therefore EPBD demonstrated as a safe and effective alternative to EST in management of common bile duct stones.