内镜下乳头球囊扩张术和乳头括约肌切开术治疗胆总管结石的比较

A comparison of endoscopic papillary balloon dilation and endoscopic sphincterotomy for the removal of common bile duct stones

目的探讨内镜下乳头球囊扩张术（EPBD）治疗胆总管结石的有效性和安全性。方法2005年6月至2007年5月山东大学齐鲁医院320例拟行内镜下取石的胆总管结石患者，随机分为EPBD组及内镜下乳头括约肌切开术（EST）组，每组160例。EPBD组在乳头球囊扩张后用取石网篮或气囊取石，当结石较大时先行机械碎石网篮碎石后再取石；EST组按常规操作。两组术后均常规鼻胆管引流3d，并造影复查。结果EST组及EPBD组分别有156例（97．5％）及157例（98．1％）成功取净结石，其中各有112例（70．0％）及104例（65．0％）一次完成；机械碎石网篮应用比例分别为20．0％（32／160）和22．5％（36／160）；术后早期并发症的总发生率分别为5．6％及8．1％，无死亡病例。随访3年，EST组胆管结石复发率（7．5％）高于EPBD组（2．5％），P〈0．05。结论EPBD取石具有与EST取石相近的成功率，经术后常规鼻胆管引流处理后，胰腺炎发生率无明显升高。EPBD可以作为胆总管结石的备选治疗措施，尤其是对不适于EST的患者。

Objective To explore the effectiveness and safety of endoscopic papillary balloon dilation（ EPBD ） for the removal of common bile duct stones. Methods Three hundred and twenty consecutive patients with common bile duct stones on endoscopic retrograde cholangiopancreatography （ERCP） who met all eligibility criteria were randomly assigned endoscopic sphincterotomy （EST） or EPBD. Complications were classified by an expert panel unaware of treatment allocation and outcome. Results After a single ERCP, all stones were removed from 112 patients （70%） assigned EST and 104 （65%） assigned EPBD. Mechanical lithotripsy was used to fragment stones in 36 （22. 5% ） EPBD procedures and 32 （ 20. 0% ） EST procedures. Early complications occurred in 5.6% EST patients and 8. 1% EPBD patients. No patient died. Gallstone disease recurrence, which is a long-term complication, is 7. 5% （12/ 160 ） in EST patients and 2. 5 % （4/160） in EPBD patients, P 〈 0. 05. Conclusions The success rate of EPBD was similar to that of EST. We found no evidence of previously suggested higher risk of pancreatitis with EPBD, and suggest that EPBD is preferred in patients who are not suitable for EST, such as those with high risk of bleeding. This procedure is a valuable alternative to EST in patients with bile duct stones.