乳头肌切开并气囊扩张术治疗胆总管结石的效果

ENDOSCOPIC SPHINCTEROTOMY PLUS ENDOSCOPIC PAPILLARY BALLOON DILATION FOR COMMON BILE DUCT STONES

目的探讨乳头肌切开并乳头气囊扩张术（EST＋EPBD）治疗胆总管结石的效果。方法 2010年8月—2013年10月,我院住院治疗的胆总管结石病人420例,病人随机分为两组,分别行EST（A组）或EST＋EPBD（B组）治疗,观察并记录两组一次性结石取净率、总结石取净率、短期并发症发生率、手术时间、X线曝光时间及使用机械碎石情况。结果 B组一次性结石取净率高于A组,机械碎石使用率低于A组,X线曝光时间及手术时间均短于A组,差异有显著性（t=10.102、6.480,χ~2=17.729、26.875,P〈0.05）。A组与B组总并发症发生率及急性胰腺炎发生率比较,差异均无显著性（P〉0.05）。B组出血发生率低于A组,差异有显著性（χ~2=6.698,P〈0.05）。两组均无穿孔发生。结论 EST＋EPBD治疗胆总管结石安全有效,而且相比于EST疗效更高,值得在临床中推广使用。

Objective To assess the efficacy of endoscopic sphincterotomy（ EST） plus endoscopic papillary balloon dilation（ EPBD） for common bile duct stones（ CBDSs）. Methods Between August 2010—October 2013,420 patients with CBDSs were hospitalized. The patients were randomized to EST group（ group A） or EST ＋ EPBD（ group B）. The success rate of complete stone removal in the first session,overall success rate of stone removal,short-term complications,operation time,X-ray exposure time and use of mechanical lithotripsy were observed and recorded. Results Compared with group A,the first-session success rate of complete stone removal in group B was higher,and time of X-ray exposure and operation were shorter,the differences between the two groups being statistically significant（ t= 10. 102,6. 480; χ~2= 17. 729,26. 875; P 〈 0. 05）,as for the total complication and incidence of acute pancreatitis,the differences between the two groups were not significant（ P 〉 0. 05）. With regard to posto-perative hemorrhage,group B was lower versus group A（ χ~2=6. 698,P 〈 0. 05）. No perforations were noted in both groups. Conclusion Endoscopic sphincterotomy plus balloon dilation is safe and effective for common bile duct stones,which is better than using endoscopic sphincterotomy alone. This combined technique is worth promoting in clinical application.