内镜下乳头括约肌小切开联合气囊扩张术治疗老年胆总管结石疗效及对血淀粉酶的影响

Small endoscopic sphincterotomy plus large balloon dilation in treatment of elderly patients with common bile duct stones and its' impact on blood amylase

目的观察乳头括约肌小切开联合气囊扩张术（EPLBD）对老年胆总管结石患者的疗效及对血淀粉酶的影响。方法将该院2010年1月-2014年12月256例年龄大于60岁（平均72.6岁）的老年胆总管结石（直径大于10 mm）患者随机分为EPLBD（n=129）及内镜下乳头括约肌切开术（常规EST）（n=127）两组,均根据实际情况行碎石术、网篮取石术和（或）气囊取石,直径大于25 mm巨大结石先置入胆管塑料支架,3个月后择期取石,同时观察两组胰腺炎发生率、术后4、12和24h血淀粉酶结果。结果 EPLBD组与常规EST组比较,一次性取石成功率分别为88.37%与88.97%（P〉0.05）、取石时间分别为（25.0±5.2）及（45.0±11.1）min（P〈0.05）、需机械碎石率分别为8.00%及36.00%（P〈0.05）,胰腺炎发生率分别为5.26%及6.19%（P〉0.05）,术后4、12和24 h血淀粉酶水平无明显差异。EPLBD术,无术后大出血发生,常规EST组3例术后24-48 h发生大出血,经再次内镜下止血好转。结论 EPLBD术治疗老年胆总管结石,与常规EST组比较,疗效确切、操作时间短,需要较少的机械碎石术,而并不增高血淀粉酶水平及胰腺炎发生,发生术后大出血几率低,在胆总管结石取石治疗中更为有效、安全。

Objective To evaluate the efficacy and safety of small endoscopic sphincterotomy plus large balloon dilation（EPLBD） for removal of common bile duct stones larger than 10 mm in the elderly patients with common bile ducts stones. Methods From January 2010 to December 2014, 256 elderly patients with CBD stones were randomly divided into 2 groups, to receive EPLBD（n = 129） or EST only（n = 127）. The efficacy and impact on blood amylase were observe and studied. Results The success rates of the initial lithotomy were similar between the two groups（88.37% vs 88.97%）. Complications due to treatment procedure occurred similarly between the two groups（13.17%vs 14.17%）. There was no significant difference between the level of blood amylase 4, 12, 24 hours after surgery between the two groups. Conclusion EPLBD is as effective and safe as EST for elderly patients with CBD stones larger than 10 mm, and is more efficient in terms of procedure time.