EST联合EPLBD不同扩张时间在胆总管结石中的应用

The application of endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in the treatment of choledocholithiasis

目的探讨内镜下乳头肌切开(EST)联合内镜下十二指肠乳头大球囊扩张术(EPLBD)下不同扩张时间对治疗胆总管结石的影响。方法选取采用EST联合EPLBD进行胆总管结石治疗的患者128例,按不同球囊扩张时间分为0 min组、1 min组、3 min组及5 min组,各组球囊扩张至所需直径后分别维持相应时间减压拔除球囊。术后常规监测及治疗,所有患者观察48 h以上确定是否发生胰腺炎、出血等早期并发症。根据结石最大直径、扩张直径、球囊扩张直径、内镜逆行胰胆管造影(ERCP)操作时间、碎石器使用情况来评估EPLBD的有效性,以术后胰腺炎、出血、穿孔等并发症发生情况评估其安全性。结果所有患者均顺利取石。各组结石最大直径、胆管扩张直径以及球囊扩张直径差异均无统计学意义。各组患者均无出血、穿孔、胆道感染及急性胰腺炎发生;各组碎石器使用率差异无统计学意义;0、1及3 min组ERCP操作时间呈先降后升趋势(P<0.05),但3 min组操作时间与0 min组比较差异无统计学意义;各组高淀粉酶血症发生率差异无统计学意义。结论 EST+EPLBD不同扩张时间治疗胆总管结石早期安全有效,其中1 min组疗效较好。

Objective To investigate the effect of endoscopic sphincterotomy(EST)combined with endoscopicpapillary large balloon dilation(EPLBD)in the treatment of common bile duct stones.Methods A total of128patientstreated with EST combined with EPLBD for common bile duct stones were divided into0min group,1min group,3mingroup and5min group,according to the different balloon expansion times.The balloon was extended to the requireddiameter and was maintained to the corresponding time,and then decreased the pressure to remove the balloon.Patientswere given routine monitoring and treatment after operation.All patients were observed more than48h to determine whetherthere were early complications such as pancreatitis and bleeding.The effectiveness of EPLBD was evaluated by the stonediameter,expansion balloon diameter,ERCP operation time and use of stone breaker.The safety was evaluated by theoccurrence of complications including postoperative pancreatitis,bleeding and perforation.Results All patients weresuccessfully removed stones.There were no significant differences in the maximum diameter of stone,the diameter of bileduct dilatation and the diameter of balloon dilatation between groups.No bleeding,perforation,biliary tract infection andacute pancreatitis were found in patients.There were no significant differences in the utilization rates of stone breakerbetween groups.ERCP operation times showed a trend of decreased first and then increased in0,1and3min groups(P<0.05).There was no significant difference in ERCP operation time between3min group and0min group.There were nosignificant differences in incidence rates of high amylase between groups.Conclusion EST combined with EPLBD is asafe and effective treatment for early stage of larger common bile duct stones,of which1minute group shows better effect.