经内镜乳头括约肌切开术与小切开联合球囊扩张术治疗胆总管结石的疗效及并发症对比研究

Efficacy and complications in endoscopic sphincterotomy and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation for choledocholithiasis

目的比较经内镜乳头括约肌切开术（EST）与小切开联合球囊扩张术（ESBD）治疗胆总管结石的疗效及并发症。方法120例胆总管结石（结石直径≤2cm）接受内镜取石治疗的患者，随机抽取60例行EST（EST组），另外60例行ESBD（ESBD组）。比较两组净石率、术后胰腺炎、出血、穿孔、结石复发的情况。结果EST组和ESBD组分别有54例（90．0％）及56例（93．3％）一次性取石成功（r=0．436，P=0．743）；分别有11例（18．3％）及4例（6．7％）因术中见结石较大且取石困难使用机械碎石（X2=3．733，P=0．053）。EST组术后出血4例，ERCP术后胰腺炎6例，穿孔1例；ESBD组术后出血1例，ERCP术后胰腺炎4例，无穿孔病例。两组早期并发症总发生率分别为18．3％（11／60）和8．3％（5／60）（X2=3．322，P=1．422），结石复发率分别为21．7％（13／60）和6．7％（4／60）（X2=5．551，P=0．034）。结论ESBD组治疗胆总管结石的一次取石成功率及术后早期并发症发生率与EST组差异无统计学意义，但远期结石复发率ESBD组低于EST组。对于逐渐年轻化的胆总管结石患者，ESBD技术因其保留括约肌功能，成为治疗胆总管结石更安全有效的方法。

Objective To compare efficacy and complications of endoscopic sphincterotomy（EST） and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation （ESBD） for choledocholithiasis. Methods A total of 120 choledocholithiasis patients （stone diameter≤2 cm）underwent endoscopic treatment, including 60 cases of EST, 60 ESBD. The stone-free rate, complication rate of post- ERCP pancreatitis, hemorrhage, perforation and recurrence rate of stones were compared between two groups. Results Success rates of one-time removal were 90. 0% （54 cases） and 93.3% （56 cases） in group EST and ESBD （X2 = 0. 436, P = 0. 743）. Eleven case （ 18. 3%） and 4 case （ 6. 7%） underwent mechanical lithotripsy（X2 = 3. 733 ,P= 0. 053）. There were 4 cases of hemorrhage, 6 post-ERCP pancreatitis and 1 perforation in EST group, while in ESBD group, there was 1 case of hemorrhage, 4 pancreatitis and no perforation. The total rates of early complications were 18. 3% （11/60） and 8. 3% （5/60） in two groups （X2 =3. 322,P= 1. 422） and recurrence rate of stones were 21.7%（13/60） and 6. 7%（4/60） respectively （X2= 5. 551, P = 0. 034）. Conclusion There are no significant differences between EST group and ESBD group in treatment of choledocholithiasis, in success rate of one-time removal and the occurrence of early complications, but the recurrence rate of late complications in ESBD group is lower than that in EST group. ESBD shows high efficacy and safety for younger patient of choledocholithiasis.