内镜下十二指肠乳头小切开联合乳头球囊扩张术治疗胆总管较大结石临床观察

Clinical observation of small endoscopic sphincterectomy combined with endoscopic papillary balloon dilation in the treatment of large common bile duct stones

目的 观察内镜下十二指肠乳头小切开（SES）联合内镜下乳头球囊扩张术（EPBD）治疗胆总管较大结石的临床效果. 方法 将患者随机分为大切口乳头括约肌（EST）组、EPBD组及SES联合EPBD组,每组各30例.统计术后1周内胰腺炎发生率和术后15个月内胆总管结石复发率. 结果 术后1周内胰腺炎发生率大切口EST组（1/30,3.3％）、SES联合EPBD组（1/30,3.3％）,两组均低于EPBD组（6/30,20.0％）（P＜0.05）,术后15个月内胆总管结石复发率EPBD组（1/30,3.3％）、SES联合EPBD（1/30,3.3％）,两组低于大切口EST组（7/30,23.3％）（P＜0.05）.结论 SES联合EPBD治疗胆总管较大结石,既能够降低术后急性胰腺炎的发生率,也能够降低远期胆总管结石的复发率.

Objective To observe the clinical effect of small endoscopic sphincterectomy （SES） combined with endoscopic papillary balloon dilation （EPBD） in the treatment of large common bile duct stones.Methods The patients were randomly divided into 3 groups：normal endoscopic sphincterotomy（EST）,EPBD,SES combined with EPBD.The incidence of pancreatitis at 1 week after operation and the recurrence rate of inner duct stone within 15 months after operation were statistically analyzed.Results At 1 week after treatment,the incidence of pancreatitis was lower in group EST and group SES combind with EPBD than in group EPBD [3.3% （1/30）,3.3% （1/30） vs.20.0% （6/30）,both P〈0.05].After 15 months of treatment,the recurrence rate of inner duct stone were lower in group B and group C than in group A 3.3% （1/30）,3.3% （1/30） vs.23.3%（7/30）,both P〈0.05）.Conclusions In the treatment of large common bile duct stones,SES combined with EPBD can reduce the incidence of postoperative acute pancreatitis and the longterm recurrence rate of common bile duct stones.