ERCP中SEST联合EPBD对比单纯EST对胆总管结石取石的临床分析

Comparison of the clinical analysis of SEST combined with EPBD and EST in treatment of choledocholithiasis

目的观察经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术中改良的内镜括约肌切开术(small endoscopic sphincterotomy,SEST)联合内镜乳头气囊扩张术(endoscopic papillary balloon dilation,EPBD)对比单纯EST对胆总管结石(直径>10 mm)取石术后并发症及取石成功率的效果。方法将收集的72例胆总管结石患者按照随机数字表法分为单纯EST组(36例)和SEST联合EPBD组(36例)。比较两组取石成功率、术后3 h和24 h血淀粉酶水平、总住院天数及出血、穿孔、死亡以及术后1年胆总管结石复发率。结果 SEST联合EPBD组与单纯EST组比较,术后3 h、24 h血淀粉酶值差异有统计学意义(P<0.05);单纯EST组术后出血、穿孔、死亡率与SEST联含EPBD组比较,差异无统计学意义(P>0.05)。住院天数及术后均随访1年胆管结石复发率单纯EST组高于SEST联合EPBD组,差异有统计学意义(P<0.05)。结论 SEST联合EPBD相对于单纯EST取石成功率相当,术后并发症发生率降低,且更为安全经济,有望成为今后内镜下治疗胆总管结石的趋势。

Objective To observe the clinical effect and the complications of small endoscopic sphincterotomy （SEST） combined with endoscopic papillary balloon dilation （EPBD） and simple endoscopic sphincterotomy （EST） during endoscopic retrograde eholangiopancreatography （ERCP） in the treatment of choledocholithiasis. Methods Total 72 patients with choledocholithiasis were randomly divided into two groups： 36 cases in simple EST group and 36 cases in SEST ＋ EPBD group. The successful rate of stone removal, 3 hours/24 hours serum amylase levels, the total number of days of hospitalization, bleeding, perforation, death and recurrence rate of bile duet stones after 1 year were compared between two groups. Results Compared with simple EST group, the 3 hours/24 hours serum amylase levels were signif- icant lower in SEST combined EPBD group（P 〈 0.05）. There were no significant differences in the postoperative bleed- ing, perforation, death rates between simple EST group and SEST combined EPBD group （P 〉 0.05）. There were sig- nificant differences in the hospitalization days and the recurrence rate of bile duct stone after one year follow-up between simple EST group and SEST combined with EPBD group （P 〈 0. 05）. Conclusion Compare with simple EST, SEST combined EPBD has the same stone successful rate of stone removal. However SEST combined with EPBD has less post- operative complications. SEST combined with EPBD will become a new trend in endoscopic treatment of bile duct stones.