内镜下乳头小切开联合球囊扩张治疗胆总管结石的临床观察

Clinical observation of choledocholithiasis carried out by endoscopic sphincterotomy small incision combined with papillary balloon dilatation

目的观察内镜下乳头小切开联合球囊扩张(EST+EPBD)治疗胆总管结石的手术效果。方法将192例胆总管结石患者随机分为EST组和EST+EPBD组,每组96例,比较两组的术后疗效。结果与EST组比,EST+EPBD组的平均手术时间、住院时间明显缩短;而一次性取石成功率及总取石成功率,EST+EPBD组均明显高于EST组。EST+EPBD组术中术后并发症发生率(如出血、胰腺炎、胆道内钡剂反流、结石复发)少于EST,差异有统计学意义(P<0.05)。结论内镜下乳头小切开联合球囊扩张可提高较大的胆总管结石取石成功率和减少术后并发症,安全且疗效满意。

Objective To observe the therapeutic effectiveness of endoscopic sphincterotmy associated with papillary balloon dilatation in treatmen of choledocholithiasis. Methods One hundred and ninty-two cases of choledocholithiasis were randomly divided into two groups, in which 96 cases were treated with endoscopic sphincterotmy only, while in whom 96 cases were treated with papillary balloon dilatation besides endoscopic sphincterotmy. The efficacy of these two groups were evaluated. Results Between the two groups, there were significant differences in mean operation time and hospitalization time in comparison （P〈0.05）, those in EST＋EPBD group were markedly reduced. The number of disposable stone and total successful stone in EST＋EPBD group were evidently higher than those of EST group. Between the two groups, there were significant differences in bleeding, pancreatitis, biliary barium reflux, stone recurrence and other complications in comparison （P〈0.05）, the numbers of postoperative complications in the treatment of patients in EST＋EPBD group were sharply reduced. Conclusion Endoscopic sphincterotmy associated with papillary balloon dilatation can raise taking off stone＇s success rate and reduce postoperative complications. This way is safe and has a satisfactory outcome.