内镜下乳头括约肌小切开联合球囊扩张术治疗胆总管结石的临床效果分析

Analysis of clinical effect of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilatation in the treatment of common bile duct stones

目的分析对胆总管结石患者给予内镜下乳头括约肌小切开(SEST)联合球囊扩张术(EPBD)治疗的临床应用效果。方法 180例胆总管结石患者,采用随机分组法分为联合组和对比组,各90例。联合组患者采用内镜下SEST联合EPBD治疗,对比组患者采用内镜下乳头括约肌切开术(EST)治疗。观察比较两组患者首次结石取出成功率、机械碎石器使用率;术后观察高淀粉酶血症、急性胰腺炎、出血、穿孔等近期并发症发生情况。结果两组患者首次结石取出成功率比较差异无统计学意义(P>0.05);联合组患者机械碎石器使用率为14.4%,明显低于对比组的28.9%,差异具有统计学意义(P<0.05);联合组近期并发症发生率为16.7%,低于对比组的28.9%,差异具有统计学意义(P<0.05)。结论胆总管结石采用内镜下SEST联合EPBD治疗的临床效果显著,术后并发症较少,值得临床推广和应用。

Objective To analyze the clinical application effect of small endoscopic sphincterotomy（SEST） combined with endoscopic papillary balloon dilatation（EPBD） in the treatment of common bile duct stones.Methods A total of 180 common bile duct stones patients were divided by random grouping method into combination group and control group,with 90 cases in each group.The combination group was treated with endoscopic SEST and EPBD,and the control group was treated with endoscopic sphincterotomy（EST）.Observation and comparison were made on success rate of first stone removal and utilization rate of mechanical lithotripsy between two groups.Observation were made on occurrence of postoperative complications of amylase,acute pancreatitis,bleeding and perforation.Results Both groups had no statistically significant difference in success rate of first stone removal（P〉0.05）.The combination group had obviously lower utilization rate of mechanical lithotripsy as 14.4% than 28.9% in the control group,and the difference was statistically significant（P〈0.05）.The combination group had lower incidence of recent complications as 16.7% than 28.9% in the control group,and the difference was statistically significant（P〈0.05）.Conclusion Endoscopic SEST and EPBD shows remarkable clinical effect for common bile duct stones with less postoperative complications,and it is worthy of clinical promotion and application.