内镜下乳头括约肌小切开联合球囊扩张术(ESBD)治疗胆总管结石合并肝硬化的疗效评估

Efficacy evaluation of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation(ESBD)in treating choledocholithiasis combined with cirrhosis

目的：研究内镜下乳头括约肌小切开联合球囊扩张术（ESBD）治疗胆总管结石合并肝硬化的疗效.方法：选择接受ESBD治疗的胆总管结石合并肝硬化患者作为ESBD组（n=52）,选择接受内镜下十二指肠乳头球囊扩张术（EPBD）治疗的胆总管结石合并肝硬化患者作为EPBD组（n=52）.比较两组手术情况、术后血淀粉酶变化趋势以及炎症介质含量.结果：ESBD组的结石完全清除率和一次性清除率均高于EPBD组;ESBD组血淀粉酶含量从术后第4天开始降低,EPBD组血淀粉酶含量从术后第6天开始降低;术后1～7 d时,ESBD组血淀粉酶含量均低于EPBD组;术后第7天时,ESBD组血清中肿瘤坏死因子-α（TNF-α）、白介素-1β（IL-1β）、白介素-6（IL-6）IL-6、高迁移率族蛋白1（HMGB1）、单核细胞趋化蛋白-1（MCP-1）的含量低于EPBD组.结论：ESBD治疗胆总管结石合并肝硬化的取石效果优于EPBD;ESBD能够提高结石清除率、减轻十二指肠乳头水肿、缓解炎症反应程度.

Objective： To study the efficacy of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation （ESBD） in treating choledocholithiasis combined with cirrhosis. Methods： Pholedocholithiasis combined with cirrhosis patients who underwent ESBD were enrolled in ESBD group （n= 52）, and choledocholithiasis combined with cirrhosis patients who underwent endoscopic papillary balloon dilation （EPBD） were enrolled in EPBD group （n=52）. Then surgery condition, postoperative serum amylase trend and inflammatory mediator contents of two groups were compared. Results.. Complete stone clearance rate and one-time clearance rate of ESBD group were higher than those of EPBD group; serum amylase content of ESBD group began to decrease from the 4th day after surgery, and serum amylase content of EPBD group began to decrease from the 6th day after surgery; 1 d-7 d after surgery, serum amylase contents of ESBD group were lower than those of EPBD group; 7 d after surgery, serum TNF-α, IL-1β, IL-6, HMGB1 and MCP-1 contents of ESBD group were lower than those of EPBD group. Oonclusion.. Stone extraction effect of ESBD in treating choledocholithiasis combined with cirrhosis is better than that of EPBD; ESBD can improve stone clearance rate, reduce duodenal papillary edema and relieve inflammation degree.