内镜乳头球囊扩张术治疗非扩张性肝外胆管结石的疗效分析

Efficacy of endoscopic papillary balloon dilation in the treatment of non-dilated extrahepatic biliary stones

目的 分析内镜乳头球囊扩张术（EPBD）和EST治疗非扩张性肝外胆管结石的疗效.方法 回顾性分析1999年1月至2008年4月太钢总医院收治的317例非扩张性肝外胆管结石患者的临床资料.其中119例行EPBD治疗,198例行EST治疗.各选取62例进行对照研究,分别设为EPBD组和EST组.EPBD组的患者在经ERCP检查确诊后,沿导丝置入柱状球囊,使其中部位于十二指肠乳头开口处.完成扩张后,用网篮或拖石气囊取石,术后常规行ENBD.EST组的患者在经ERCP检查确诊后,采用退刀切开法切开十二指肠乳头,在数字减影血管造影X线监视下,用网篮或拖石气囊取石.两组疗效分析采用χ2检验.结果 EPBD组和EST组的一次取石成功率分别为92%（57/62）和94%（58/62）,两组比较,差异无统计学意义（χ^2=0.222,P〉0.05）.EPBD组患者发生高淀粉酶血症、胰腺炎的例数略多于EST组,而发生十二指肠穿孔的例数略少于EST组,两组比较,差异均无统计学意义（χ ^2=0.286,1.000,2.000,P〉0.05）.EPBD组患者发生乳头出血和胆道感染的例数明显少于EST组（χ^2=4.000,7.000,P〈0.05）.两组患者均随访24个月.在术后的第6、12、24个月的随访统计中,EPBD组出现胆管结石复发及胆道逆行感染的例数明显少于EST组（χ^2=4.000、5.000、6.000,6.000、8.000、11.000,P〈0.05）.结论 EPBD后取石＋ENBD是治疗非扩张性肝外胆管结石的首选.该方法具有保护十二指肠乳头的功能、创伤小、恢复快等优点.

Objective To investigate the efficacy of endoscopic papillary balloon dilation （EPBD） and endoscopic sphincterotomy （EST） in the treatment of non-dilated extrahepatic biliary stones. Methods The clinical data of 317 patients with non-dilated extrahepatic biliary stones who were admitted to the Taiyuan Iron and Steel Corporation Hospital from January 1999 to April 2008 were retrospectively analyzed. Of all patients, 119 received EPBD treatment, and the remaining 198 received EST treatment. Sixty-two patients treated by EPBD （EPBD group） and 62 by EST （EST group） were selected to conduct the matched-pair analysis. In the EPBD group, a cylindrical balloon was inserted under the guidance of a guidewire after the conclusive diagnosis by endoscopic retrograde cholangiopancreatography. After the dilation, stones were extracted by a stone basket or a balloon, and then conventional endoscopic nasobiliary drainage was carried out. In the EST group, stones were extracted by a stone basket or a balloon under the monitor of the digital subtraction radiography after incision of the duodenal papilla. The efficacy of the two methods was compared using the chi-square test. Results The stonefree rate in one session was 92% （57/62） in the EPBD group and 94% （58/62） in the EST group, with no significant difference between the two groups （ χ ^2 = 0.222, P 〉 0.05 ）. The number of patients who were complicated with hyperamylasemia and pancreatitis was slightly greater, and the number of patients who were complicated with duodenal perforation was smaller in the EPBD group than those in the EST group, while there was no significant difference between the two groups （ χ ^2 = 0. 286, 1. 000, 2.000, P 〉 0.05 ）. The numbers of patients who were complicated with duodenal papilla bleeding or biliary infection in the EPBD group were significantly smaller thanthose in the EST group （ χ^ 2 = 4. 000, 7. 000, P 〈 0.05 ）. All patients were followed up for 24 months. The recurrence rate of bile duct stone and the incidence of biliary infection in the EPBD group were significantly lower than those in the EST group at the end of 6, 12 and 24 months （χ^2 =4. 000, 5. 000, 6.000; 6.000, 8.000,11. 000, P 〈 0.05 ）. Conclusions Combined application of EPBD and ENBD has the advantages of minor trauma and quick recovery of patients. It can preserve the function of duodenal papilla, so it is the first choice for treating non-dilated extrahepatic biliary stones.