胆总管结石患者的内镜逆行胰胆管造影联合内镜括约肌切开术取石的效果研究

Effect of ERCP combined EST on patients with common bile duct calculi

目的探讨将内镜逆行胰胆管造影术(ERCP)联合内镜括约肌切开术(EST)应用于胆总管结石的临床效果。方法选取2014年1月-2014年12月于该院手术治疗的300例胆总管结石患者为研究对象,采用随机数字表法将患者分为ERCP联合EST组和开腹组,每组150例,比较两组患者术中及术后恢复情况、术后并发症的发生率、医疗费用及生活质量。结果与开腹组相比,ERCP联合EST组的手术时间、术中出血量、黄疸消退时间、术后肛门排气时间、卧床时间、术后抗感染时间及住院时间均明显缩短,差异有统计学意义(P<0.05)。ERCP联合EST组的手术费用明显高于开腹组(P<0.05),但其住院总费用与开腹组差异无统计学意义(P>0.05)。两组患者术后胆管炎、胰腺炎及结石复发率差异无统计学意义(P>0.05),ERCP联合EST组患者高淀粉酶血症的发生率为18.7%(28/150),明显高于开腹组6.0%(9/150)(P<0.05)。出院时,ERCP联合EST组患者生活质量的改善程度优于开腹组患者,差异有统计学意义(P<0.05)。结论采用ERCP取石术联合EST治疗胆总管结石有较高的有效性和安全性,能够更好地改善患者的生活质量。

Objective To explore the effect of ERCP combined endoscopic sphincterotomy（EST） on patients with common bile duct calculi. Methods 300 patients with choledocholithiasis admitted in our hospital from January 2014 to December 2014 were randomly divided into ERCP and EST group（n = 150） and the control group（n = 150）.Compare the surgery condition and postoperative recovery, incidence of postoperative complications, health care costs and quality of life between the two groups. Results Compared with open surgery group, operative time, blood loss, jaundice subsided time, postoperative anal exhaust time, postoperative recovery time, postoperative anti-infection and hospitalization time in ERCP and EST group were significantly shortened, the differences were statistically significance（P〈0.05）. Costs of ERCP and EST operation were significantly higher than control group（P〈0.05）, but the total cost of hospitalization in the two groups had no significant difference（P〈0.05）. The incidences of postoperative cholangitis, pancreatitis and stone recurrence in the two groups had no significant difference（P〈0.05）. The rate of hyperamylasemia in ERCP and EST group rate was 18.7%（28/150）, significantly higher than the control group 6.0%（9/150）（P〈0.05）. The discharge time, improvement degree of life quality of patients in ERCP and EST group was more than control group, the differences were statistically significant（P〈0.05）. Conclusion Stone extraction via ERCP and EST has higher efficacy and safety in the treatment of eholedocholithiasis, which is better for improving the quality of life of patients.