内镜下十二指肠乳头小切开后球囊扩张术治疗胆总管结石的临床研究

Clinical evaluation of small endoscopic sphincterotomy plus balloon dilation for common bile duct stones

目的探讨内镜下十二指肠乳头括约肌小切开后球囊扩张术在胆总管结石治疗中的有效性和安全性。方法将150例临床确诊为胆总管结石的患者随机分为乳头括约肌切开组(EST组)和乳头括约肌小切开后球囊扩张术组(SEST+EPBD组),比较两组疗效及并发症的发生率。结果 EST组和SEST+EPBD组取石成功率分别为92%和97%(χ2=1.19,P>0.05)。EST组术后出现急性胰腺炎2例,出血4例,结石复发11例,逆行性胆道感染15例。SEST+EPBD组术后出现急性胰腺炎1例,出血1例,结石复发2例,逆行性胆道感染6例。两组取石成功率及近期并发症比较差异无统计学意义(P>0.05),远期并发症比较差异有统计学意义(P<0.05)。结论内镜下乳头括约肌小切开后球囊扩张术治疗胆总管结石安全、有效,并发症少,并且尽可能的保留了十二指肠乳头括约肌的功能,值得临床推广。

Objective To evaluate the therapeutic efficacy and safety of small endoscopic sphincteroto-my （EST） plus balloon dilation for common bile duct stones. Methods One hundred and fifty patients with common bile duct stones were randomly divided into two groups to receive EST and SEST＋EPBD. The treat-ment outcomes and the incidence of complications were compared between the two groups. Results Success-ful clearance of bile duct stones was 92%in EST group, and 97%in SEST＋EPBD group （χ2=1.19, P〉0.05）. Acute pancreatitis occurred in 2 patients, biliary tract bleeding in 4 patients, recurrent bile duct stones in 11 pa-tients, 1 retrograde biliary tract infection in 15 patients in EST group, while acute pancreatitis in 1 patient, bil-iary tract bleeding in 1 patient, recurrent bile duct stones in 2 patients, retrograde biliary tract infection in 6 pa-tients in SEST＋EPBD group. The difference of stone-free rate, short-term complications in the two groups were not statistically significant （P〉0.05）, but the long-term complications was significantly higher in EST group （P〈0.05）. Conclusion Endoscopic papillary sphincter small incision combined with balloon dilatation in the treatment of common bile duct stones is safe, effective, and less complications.