经胆囊管置管乳头扩张术治疗胆总管结石

Percutaneous trans-cholecysfic balloon dilation of the papilla for clearance of common bile duct stones

目的探讨经皮经胆囊管入路乳头扩张术治疗胆总管结石的临床效果。方法2011年2月至2014年2月威海市立医院诊治41例胆总管结石患者，随机分为经胆囊入路乳头扩张组（trans—cholecystic dilation of the papilla，TCDP）20例及内镜乳头切开组（endoscopic sphincterotomy，EST）21例。比较胆总管结石清除率；术后近期并发症（胰腺炎、胆管炎、胆道出血）发生率及随访术后2年胆囊储存收缩功能、胆管结石复发、急性胆管炎、胆囊结石、胆道积气发生率。结果胆总管结石彻底清除率、术后并发症总发生率及胆囊结石彻底发生率两组比较差异无统计学意义。随访术后2年TCDP组及EST组胆道积气发生率分别为16．7％及68．4％（P=0．006）：胆总管结石复发率为5．6％％及36．8％（P=0．025）；空腹胆囊容积为（20．9±3．2）ml及（12．6±2．5）ml（t=8．82，P〈0．01）；餐后胆囊排出量为（10．2±2．4）ml及（6．6±1．70）ml（t=5．29，P〈0．01）；急性胆管炎发生率（P=0．034），2组比较差异均有统计学意义。结论经皮经胆囊管置管乳头扩张术与经内镜乳头切开术治疗胆总管结石近期疗效类似，前者在保存Oddi括约肌及胆囊功能、减少术后胆总管结石复发方面有优势。

Objective To investigate the effectiveness and morbidity and follow-up data of percutaneous trans-cholecystic balloon dilation of the papilla （PCDP） for clearance of common bile duct （CBD） calculi. Methods From Feb. 2011 to Feb. 2014, 41 patients with choledocholithiasis were admitted to Weihai Municipal Hospital, of which 20 cases were assigned to percutaneous trans-cholecystic balloon dilation of the papilla （TCDP） group, whereas 21 cases to endoscopic sphincterotomy （EST） group. Complete clearance rate of CBD calculi, rate of postoperative short-term complications including acute pancreatitis and cholangitis and hemobilia, filling and emptying function of gallbladder, rate of recurrent CBD stones, gallbladder stones and cholangitis rate as well as pneumobilia rate were compared between the two groups. Results There was no significant difference in complete clearance rate of CBD calculi, short- term complications, gallbladder stone recurrence during follow-up between the two groups. Significant differences were observed in a follow-up of 24 months between TCDP group and EST group in pneumobilia rate （ 16. 7% vs 68.4%, P = 0. 006）, rate of recurrent CBD stones （5.6% vs 36. 8%, P = 0. 025 ）, fasting gallbladder volume [ （20. 9 ± 3.2） ml vs （ 12. 6 ± 2. 5 ） ml, t = 8.82, P 〈 0.01 ], gallbladder contractibility after a meal [ （ 10. 2 ± 2.4） ml vs （6. 6 ± 1.7） ml, t = 5.29, P 〈 0. 01 ], and cholangitis rate （ 11.1% vs 42. 1% ,P = 0. 034 ）. Conclusions Balloon dilation of the papilla via percutaneous trans-cholecystic cannulation was as safe and effective as endoscopic sphincterotomy for removal of CBD stones. The technique of TCDP has the advantage in preserving the function of sphincter of Oddi and gallbladder as well as lower rate of postoperative recurrent CBD calculi in 2 years＇ follow-up.