内镜下乳头小切开联合球囊扩张治疗胆总管结石合并十二指肠乳头旁憩室的价值

Endoscopic papillary small incision combined with balloon dilation in the treatment of choledocholithiasis combined with duodenal papillary diverticulum value

目的探讨内镜下乳头小切开联合球囊扩张治疗胆总管结石合并十二指肠乳头旁憩室(PAD)的价值。方法回顾性分析2015年1月至2017年1月收治的胆总管结石合并PAD患者118例,按照手术方法将其分为s EST+EPBD组(60例)和EST组(58例),比较两组的ERCP成功率和一次性取石成功率,手术前后血清TBil和DBil水平的变化以及术后并发症的发生率。结果 s EST+EPBD组的ERCP成功率和一次性取石成功率均显著高于EST组(P<0.05);两组患者术后血清TBil和DBil水平较术前均明显减少,差异具有统计学意义(P<0.05);s EST+EPBD组患者术后并发症总发生率显著低于EST组(P<0.05)。结论对胆总管结石合并PAD患者实施内镜下乳头小切开联合球囊扩张治疗效果显著,可明显提高ERCP成功率和一次性取石成功率,有利于患者预后。

Objective To investigate the value of endoscopic papillary incision combined with balloon di-lation in the treatment of choledocholithiasis with periampullary diverticula（PAD）. Methods A total of 118 pa-tients with choledocholithiasis and PAD admitted to our hospital from January 2015 to January 2017 were retrospec-tively analyzed. According to the operation method,all patients were divided into two groups：s EST ＋ EPBD group（60 cases）and EST group（58 cases）. The success rate of ERCP and the success rate of one-step stone removal,the changes of serum TBil and DBil before and after operation,and the incidence of postoperative complicationswere compared between the two groups. Results The successful rates of ERCP and stone removal in s EST＋EPBDgroup were significantly higher than those in EST group（P〈0.05）. The levels of serum TBil and DBil in bothgroups were significantly lower than those before operation（P〈0.05）. The overall incidence of postoperative com-plications in s EST ＋ EPBD group was significantly lower than that in EST group（P〈0.05）. Conclusions Thetreatment of choledocholithiasis with PAD in patients with endoscopic papillary small incision and balloon dilationtreatment effect is significant,which can significantly improve the success rate of ERCP and success rate of one-time stone,benefitting the prognosis of patients.