内镜下乳头括约肌小切开联合大球囊扩张治疗老年胆总管多发巨大结石的效果及安全性分析

Efficacy and safety of minor endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in treatment of elderly patients with multiple large common bile duct stones

目的评估经内镜下十二指肠乳头括约肌小切开(m EST)联合内镜下乳头大球囊扩张术(EPLBD)在老年患者胆总管多发巨大结石治疗中的安全性和有效性。方法回顾性分析2012年1月-2016年12月安康市中心医院因胆总管多发大结石在内镜中心行ERCP治疗的患者229例,根据患者结石大小及胆总管形态选择手术方式。所有纳入病例按照内镜手术方式不同分为m EST+EPLBD组(治疗组)与EST组(对照组),观察2组首次取石成功率,机械碎石使用率,取石时间及并发症发生率。计量资料组间比较采用t检验,计数资料组间比较采用χ~2检验。结果治疗组(136例)与对照组(93例)比较,2组在一次取石成功率上差异无统计学意义(91.17%vs 87.10%,χ~2=0.980,P>0.05);而在取石时间及机械碎石使用率方面比较差异有统计学意义[(18.2±4.3)min vs(37.4±6.7)min,χ~2=37.1526,P<0.01;6.71%vs 40.00%,t=24.411,P<0.01]。2组在胰腺炎(2.94%vs 6.45%)、出血发生率(2.21%vs 2.15%)方面比较差异无统计学意义(χ~2值分别为1.630、0.001,P值均>0.05),无穿孔及感染等并发症的发生。结论 m EST+EPLBD治疗老年胆总管多发巨大结石,疗效确切,可有效缩短取石时间,有效减少机械碎石的使用率,从而减少结石复发几率,同时该方法不增加ERCP术后并发症,是一种安全、有效的老年胆总管巨大多发结石微创治疗方法。

Objective To investigate the clinical effect and safety of minor endoscopic sphincterotomy（m EST） combined with endoscopic papillary large balloon dilation（EPLBD） in the treatment of elderly patients with multiple large common bile duct stones.Methods A retrospective analysis was performed for 229 patients with multiple large common bile duct stones who underwent endoscopic retrograde cholangiopancreatography（ERCP） in Endoscopy Center,Ankang Municipal Central Hospital,from January 2012 to December 2016,and the surgical procedure was selected based on the size of stones and the morphology of the common bile duct.According to the endoscopic surgical procedure,the patients were divided into m EST ＋ EPLBD group（treatment group with 136 patients） and endoscopic phincterotomy（EST） group（control group with 93 patients）.The two groups were compared in terms of the success rate of first stone removal,use rate of mechanical lithotripsy（ML）,time spent on stone removal,and the incidence rate of complications.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results There was no significant difference in the success rate of first stone removal between the treatment group and the control group（91.17% vs 87.10%,χ~2=0.980,P〈0.05）,while there were significant differences in the time spent on stone removal（18.2 ± 4.3 min vs 37.4 ± 6.7 min,χ~2=37.1526,P〈0.01） and use rate of ML（6.71% vs 40.00%,t = 24.411,P〈0.01）.There were no significant differences in the incidence rates of pancreatitis（2.94% vs 6.45%,χ~2= 1.630,P〈0.05） and bleeding（2.21% vs 2.15%,χ~2= 0.001,P〈0.05） between the two groups,and no patient experienced perforation or infection.Conclusion m EST ＋ EPLBD has a good clinical effect in the treatment of elderly patients with multiple large common bile duct stones and can effectively shorten the time spent on stone removal,reduce the use rate of ML,and thus reduce the recurrence rate of stones.In addition,this method does not increase post-ERCP complications and is a safe and effective therapeutic method for multiple large common bile duct stones in elderly patients.