内镜下乳头括约肌切开联合大球囊扩张术与单用大球囊扩张术治疗胆总管结石的对比研究

Comparison between endoscopic sphincterotomy combined with large-balloon dilation and endoscopic large-balloon dilation alone in removal of large bile duct stones

目的比较内镜下乳头括约肌切开术（EST）联合大球囊扩张术（LBD）与单用LBD治疗胆总管巨大结石的疗效差异。方法回顾性分析2008年2月至2014年11月接受EST联合LBD（联合组，n=61）或单用LBD（单用组，n=48）治疗的胆总管巨大结石病例资料，对比观察2组治疗效果、并发症。结果单用组的操作时间明显少于联合组[17．3min（8—35min）比21．5min（10～42min），P=0．041]。联合组和单用组总的结石完全清除率[90．2％（55／61）比91．7％（44／48），P=1．000]和无机械性碎石下结石完全清除率[78．7％（48／61）比83．3％（40／48），P=0．542]比较，差异无统计学意义。联合组中1例患者发生大量出血，内镜下成功止血。联合组和单用组在术后胰腺炎发生率上差异无统计学意义[4．9％（3／61）比6．3％（3／48），P=1．000]。结论EST联合LBD在治疗巨大胆管结石上与单用LBD相比无明显优势。相较于EST联合LBD，单用LBD可缩短操作时间，简化操作。

Objective To compare the efficacy of endoscopic sphincterotomy （EST） combined with large-balloon dilation （LBD） and that of LBD alone for large bile duct stones. Methods Data of 61 patients who received EST combined with LBD （the combination group） and 48 patients who received LBD alone （the LBD group） from February 2008 to November 2014 were collected. The efficacy and adverse events of two groups were compared. Results The procedure time from successful cannulating to complete stone removal was shorter in the LBD group than that in the combination group [ 17.3 min （8-35 min） VS 21.5 min （ 10-42 min） , P= 0. 041]. There were no significant differences in overall complete stone removal rate [ 90. 2% （55/61） VS 91.7% （44/48）, P= 1. 000] and complete stone removal rate without mechanical lithotripsy [ 78.7% （48/61） VS 83.3% （40/48）, P= 0. 542 ] in the combination group and the LBD group. Massive bleeding occurred in one patient of the combination group, but was successfully coagulated under endoscopy. There was no significant difference in the incidence of postoperative pancreatitis between the two groups[4. 9% （3/61） VS 6. 3% （3/48）, P = 1. 000 ]. Conclusion EST combined with LBD offers no significant advantage over LBD alone for the removal of large bile duct stones. LBD can simplify the procedure compared with EST combined with LBD in terms of shortening the procedure time.