十二指肠乳头小切开联合球囊扩张术在治疗胆总管结石中的应用

Application of Small Endoscopic Sphincterotomy plus Endoscopic Papillary Balloon Dilation in Treatment of Choledocholithiasis

目的研究十二指肠乳头小切开联合球囊扩张术用于治疗胆总管结石近期发生并发症(十二指肠乳头出血、急性胰腺炎)的情况。方法 355例中国人民解放军第九四医院及中国人民解放军第八一医院的胆总管结石患者,按治疗方法分为2组,98例行十二指肠乳头小切开联合球囊扩张术(sEST+EPBD),257例行十二指肠乳头切开术(EST),对近期并发症(十二指肠乳头出血、急性胰腺炎)发生率进行对照性研究。结果十二指肠乳头出血发生率sEST+EPBD组为1.02%,EST组为6.61%,2组比较差异有统计学意义(P<0.05);急性胰腺炎发生率sEST+EPBD组为6.12%,EST组为6.23%,2组比较差异无统计学意义(P>0.05)。结论十二指肠乳头小切开联合球囊扩张术用于治疗胆总管结石,十二指肠乳头出血发生率低,急性胰腺炎发病率与单纯十二指肠乳头切开相当,又部分保留了乳头括约肌的功能。

Objective To study the effects of small endoscopic sphincterotomy(sEST) plus endoscopic papillary balloon dilation(EPBD) on recent complications of choledocholithiasis(duodenal papilla hemorrhage and acute pancreatitis). Methods A total of 355 choledocholithiasis patients from No. 94 and No. 81 Hospitals of PLA were randomly divided into endoscopic sphincterotomy(EST) group(n = 257) and sEST+EPBD group(n= 98). The incidence of recent complications was compared between the two groups. Results The incidence of duodenal papilla hemorrhage in sEST+EPBD group was significantly lower than that in EST group(l. 02% vs 6. 61%,P<C〇. 05). However,no significant difference in the incidence of acute pancreatitis was found between the two groups(6. 12% vs 6. 23% , P > 0 . 05). Conclusion The combination of sEST and EPBD for choledocholithiasis can decrease the incidence of duodenal papilla hemorrhage, partly preserve the function of duodenal papilla sphincter, and induce an incidence of acute pancreatitis that is equivalent to EST.