经内镜治疗合并乳头旁憩室的胆总管结石96例临床分析

The Clinical Analysis of 96 Cases of Common Bile Duct Calculi Combined with Juxtapapillary Diverticula by Endoscopic Therapy

目的:总结经十二指肠镜治疗合并乳头旁憩室的胆总管结石的临床效果,对比分析乳头括约肌切开术和乳头扩张术的临床疗效。方法:选取本院2009年6月-2012年6月经十二指肠镜治疗的胆总管结石伴十二指肠乳头旁憩室96例,根据手术方式不同分为两组,观察组48例采用乳头括约肌切开术(EST)治疗,对照组48例采用乳头扩张术(EPBD)治疗,两组患者均给予相同的取石球囊、机械碎石等治疗措施。对比两组患者的手术成功率及并发症情况。结果:观察组成功率为97.9%(47/48),对照组成功率为95.8%(46/48),两组患者成功率比较差异无统计学意义(P>0.05);观察组并发症发生率为8.3%(4/48),对照组为18.8%(9/48),观察组显著低于对照组,差异具有统计学意义(P<0.05)。结论:内镜下行乳头括约肌切开术治疗胆总管结石伴十二指肠乳头旁憩室的效果显著,相较于乳头扩张术安全性更好,值得在临床上推广和应用。

Objective： To summarize the clinical effect of duodenal endoscopy in the treatment of common bile duct stones combined with juxtapapillary diverticula, to analyze clinical curative effect of papilla dilatation and endoscopy sphincterotomy.Method： 96 cases of common bile duet stones combined with juxtapapillary duodenal diverticulum treated by duodenoscopic treatment in our hospital from June 2009 to June 2012 were selected , and were divided into observation group and control group according to the operation method, each of 48 cases.The observation group were given sphincterotomy （ EST ） treatment, the control group were given papillary dilatation （ EPBD ）, two groups were given the same stone balloon, mechanical lithotripsy treatment.The situation operation success rate and complications were compared between two groups.Result： The success rate of the observation group was 97.9% （ 47/48 ）, the success rate of the control group was 95.8% （ 46/48 ）, there was no significant difference （ P〉0.05 ） .The incidence of complications in the observation group was 8.3% （ 4/48 ）, which was significantly lower than 18.8% （ 9/48 ） in the control grotip, the difference was statistically significant （P〈0.05） .Conclusion： The effect of endoscopic sphincterotomy in treatment of common bile duct stones combined with juxtapapillary diverticula was obviously, it has better safety compared with the papilla dilatation, is worthy of clinical popularization and application.