经皮经肝球囊扩张术治疗胆总管结石的临床研究

Percutaneous transhepatic balloon dilation for the removal of common bile duct stones

目的探讨经皮经肝球囊扩张术治疗胆总管结石的临床应用价值。方法自2008年10月至2010年2月选取60例胆总管结石患者，分成两组，分别为经皮经肝球囊扩张取石组（percutaneous transhepatic balloon dilation，PTBD）30例、单纯乳头括约肌切开取石组（endoscopic sphincterotomy，EST）30例。PTBD组经皮经肝穿刺置入球囊扩张十二指肠乳头后行球囊取石，EST组按常规操作。两组术后均常规引流3d。结果PTBD组及EST组分别有28例（93％）及29例（97％）成功取净结石，术后早期并发症的总发生率分别为13％及17％。数据采用《检验。60例无死亡病例。随访2年，EST组胆管结石复发率及反流性胆管炎发生率高于PTBD组（Х^2=6．41，P〈0．05）。结论PTBD取石具有与EST取石相近的成功率，且可保留乳头括约肌功能，PTBD可以作为胆总管结石的治疗措施，尤其是对不适于EST的患者。

Objective To evaluate the effectiveness and safety of percutaneous transhepatic balloon dilation for the removal of common bile duct stones. Methods 60 patients of common bile duet stone were divided into two groups： PTBD group （30 cases） and endoscopic sphicterotomy （EST） group （30 cases）. Postoperatively biliary tract was drained for three days. Results All stones were removed in 28 patients （93%） in PTBD group and 29 cases （97%） in EST group. Early complications occurred in 13% in PTBD patients and in 17% in EST patients（ Х^2 = 0. 35, Х^2 = 0. 13,P 〉 0. 05）. There was no mortality in neither group. Long-term complications such as gallstone recurrence and cholangitis in PTBD group was significantly less than that in EST group（Х^2 = 6. 41 ,P 〈 0. 05 ） . Conclusions The success rate of PTBD was similar to that of EST and while in PTBD the function of Oddi＇s sphincter was well reserved. PTBD procedure is a valuable alternative to EST in patients with bile duct stones, especially in patients who are not suitable for EST.