西藏藏族人群应用ERCP联合EST治疗胆总管结石的临床研究

Clinical study of ERCP combined with EST in the treatment of common bile duct stones in tibetan population

目的分析内镜下逆行胰胆管造影(ERCP)与十二指肠乳头括约肌切开(EST)取石术对单纯胆总管结石的临床疗效。方法回顾性分析2015年5月~2017年4月西藏自治区人民医院收治的92例藏族胆总管结石患者资料,按手术方式分为观察组与对照组,观察组为ERCP联合EST组(简称ERCP组),对照组为传统外科开腹手术组。比较两组患者结石取出率、术中出血量、术中及术后并发症发生率、住院天数、住院费用等。结果观察组患者平均住院天数(17.0±11.6)天、术中出血量(20.4±5.8)ml、术中及术后并发症的发生率6.25%,对照组患者平均住院天数(31.4±9.0)天、术中出血量(100.5±18.2)ml、术中及术后并发症的发生率22.7%,因此观察组患者住院天数、术中出血量、术中及术后并发症的发生率较对照组低,差异具有统计学意义(P<0.05)。观察组结石取出率(95.8%)、住院费用(33 221.9±19 901.7)元,对照组结石取出率(100%)、住院费用(38 343.8±13 801.4)元;因此两组结石取出率及住院费用差异无统计学意义。结论 ERCP联合EST治疗单纯胆总管结石更为安全、有效,值得临床推广。

Objective To analyze the clinical efficacy of endoscopic retrograde cholangiopancreatography(ERCP) and Endoscopic Sphincterotomy(EST) in the treatment of common bile duct stones. Methods A retrospective analysis from May 2015 to April 2017 in the Tibet Autonomous Region People's Hospital included 92 cases of Tibetan patients with common bile duct stones. All patients was divided into ERCP group and surgery group. The rate of stone removal, intraoperative blood loss, intraoperative and postoperative complications, staying time in hospital and the hospitalization costs were compared between the two groups. Results The average hospitalization time is(17.0±11.6)days in ERCP group, which was shorter than surgery group(31.4±9.0)days(P<0.05). The intraoperative blood is(20.4±5.8)ml in ERCP group, which was less than surgery group(100.5±18.2)ml(P<0.05). The intraoperative and postoperative complications is 6.25% in ERCP group, which was lower than surgery group(22.7%, P<0.05). The stone removal rate is 95.8% in ERCP group and 100% in surgery group. The hospitalization expenses is(33 221.9±19 901.7)yuan in ERCP group and( 38 343.8±13 801.4)yuan in surgery group. Therefore, there was no statistically significant difference between the removal rates and hospitalization expenses of the two groups. Conclusion ERCP combined EST is safer and more effective in the treatment of simple choledocholithiasis.