内镜下十二指肠乳头括约肌小切开术联合球囊扩张术治疗胆总管结石的临床价值

Clinical application of endoscopic sphincterotomy in combination with endoscoopic papillary balloon dilatation in the treatment of common bile duct stones

目的探讨内镜下十二指肠乳头括约肌小切开术(EST术)联合球囊扩张术(EPBD术)治疗胆总管结石的临床价值。方法选择2014年1月—2016年6月在舟山医院行ERCP治疗胆总管结石的患者160例,按照手术方式的不同分为EST组(n=80)与EST+EPBD组(n=80),EST组实施EST术,EST+EPBD组实施EST术联合EPBD术。比较2组患者术中操作时间与出血量、取石成功率及术后并发症发生率等。结果与EST组相比,EST+EPBD组术后出血、急性胰腺炎、高淀粉酶血症、胆道感染、术后腹痛及总并发症显著降低(P=0.043;P=0.030;P=0.009;P=0.030;P=0.016;P<0.001);EST+EPBD组残余结石、机械碎石、结石复发、结石复发及取石时间缩短或减少(P=0.086;P=0.035;P=0.001;P=0.739;P=0.283),EST+EPBD组一次取石成功率增高(P=0.029);EST+EPBD组术中操作时间与出血量、住院与术后排便天数缩短或减少(P=0.029;P<0.001;P=0.013;P=0.002),但EST+EPBD组住院费用略增高(P=0.323)。结论 EST联合EPBD术在术后并发症及取石方面均优于单纯EST术,且在术中操作时间、术后排便时间等方面也优于EST术,值得临床推广。

Objective To investigate the clinical value of endoscopic sphincterotomy （EST） in combination with en- doscoopic papillary balloon dilatation （EPBD） in the treatment of common bile duet stones. Methods Endoscopic retro- grade cholangio pancreatography （ERCP） was performed in 160 cases of common bile duct stones in our hospital between January, 2014 and June, 2016. The patients in EST group （n = 80） received EST, while the patients in EST ＋ EPBD group （ n = 80） received EST and EPBD. The operation time, intraoperative blood loss, the success rate of lithotomy and the incidence of postoperative complications were compared between the two groups. Results Compared with EST group, postoperative bleeding, acute pancreatitis and hyperamylasemia, biliary tract infection, postoperative pain, post- operative complications and the total complications decreased in the EST ＋ EPBD group （ P = 0. 043 ; P = 0. 030 ; P = 0. 009 ; P = O. 030 ; P = 0. 016 ; P 〈 0. 001 ） ; the residual stones, mechanical lithotripsy, stone recurrence, recurrence time and stone time shortened or reduced in the EST ＋ EPBD group （P = 0. 086 ; P = 0. 035 ; P = 0. 001 ; P = 0. 739 ; P = 0. 283 ）, success rate to remove stones increased in the EST ＋ EPBD group （P =0. 029） ; intraoperative time, intrao- perative blood loss, length of stay, defecation days shortened or reduced in EST ＋ EPBD group （P = 0. 029 ; P 〈 0. 001 ; P = 0. 013; P = 0.002） ; but the cost of hospitalization in the EST ＋ EPBD group was slightly higher （P =0. 323 ）. Conclusion EST in combination with EPBD can increase the success rate of removing stones and reduce the incidence of postoperative complications, with advantage in operation duration, time to postoperative defecation and so on. It deserved to be promoted clinically.