SEST联合大球囊扩张术治疗乳头旁憩室的胆总管结石

Small endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removing choledocholithiasis in patients with peripapillary diverticulum

目的：探讨内镜下乳头括约肌小切开联合大球囊扩张术治疗合并十二指肠乳头旁憩室的难治性胆总管结石的安全性和有效性。方法：回顾性分析我院2012年11月～2015年10月期间137例合并十二指肠乳头旁憩室的难治性胆总管结石（直径≥15 mm）患者资料,其中66例行乳头括约肌小切开（SEST）联合大球囊扩张术（EPLBD）,71例行常规乳头括约肌切开术（EST）,比较两种术式的疗效及术后并发症的发生率。结果：SEST＋EPLBD组与常规EST组总体取石成功率分别为93.9%和80.3%（P=0.018）;一次性取石成功率分别为89.4%和74.6%（P=0.026）;SEST＋EPLBD组机械碎石率低于EST组（13.6%和28.2%,P=0.037）;两组术后出血、高淀粉酶血症、急性胰腺炎及穿孔的发生率均无明显差异。结论：对于合并十二指肠乳头旁憩室的难治性胆总管结石患者,SEST联合EPLBD取石成功率明显高于常规EST,是一种安全有效的治疗方法。

Objective： To assess the safety and effectiveness of small endoscopic sphincterotomy（ SEST） plus endoscopic papillary large balloon dilation（ EPLBD） for removing refractory choledocholithiasis in patients with peripapillary diverticulum.Methods： A retrospective examination was performed in137 patients with refractory choledocholithiasis stones（ diameter ≥15 mm） concomitant with peripapillary diverticulum,treated in our hospital between November 2012 and October 2015.Of the patients,66 received SEST ＋ EPLBD（ group A） and the other 71（ group B）,conventional endoscopic sphincterotomy（ EST）.The curative effects and rates of postoperative complications were compared between groups. Results： The rate of overall stone removal and complete stone removal in the first session was 93. 9% and 80. 3%,89. 4% and 74. 6% for group A and B,with significant difference（ P = 0. 018; P =0.026）,yet group A had less need for mechanical lithotripsy than group B（ 13.6% vs.28.2%,P = 0.037）. Post-operative complications,including bleeding,hyperamylasemia,pancreatitis and perforation remained no significant difference between the two groups.Conclusion： SEST ＋ EPLBD may be safe and lead to higher stone removal rate than conventional EST in treatment of refractory choledocholithiasis in patients concomitant with peripapillary diverticulum.