延长球囊扩张时间治疗胆总管结石的疗效观察

The clinical effects of prolonging balloon inflation duration for patients with common bile duct stones

目的本研究旨在比较十二指肠乳头切开联合大球囊扩张1~3 min球囊扩张持续时间与低于1 min持续时间治疗胆总管结石患者的疗效及并发症发生率。方法分析行十二指肠乳头小切开联合大球囊扩张操作的768例胆总管结石患者的临床资料,根据球囊扩张持续时间不同(1~3 min VS<1 min)分为短时扩张组与延时扩张组,分析两组患者一般资料,插管时间、手术时间、完整取石率、机械碎石率、并发症发生率(术后胰腺炎发生率、出血发生率、感染发生率、穿孔发生率)。结果短时扩张组与延时扩张组患者一般资料、插管时间、手术时间、完整取石率、机械碎石率,两组比较差异无统计学意义,延时扩张组较短时扩张组出血发生率(P=0.032)和术后胰腺炎(P=0.028)发生率较低,差异有统计学意义。结论十二指肠乳头括约肌小切开联合大球囊延时扩张治疗胆总管结石术后胰腺炎及出血发生率更低,值得临床推广及进一步应用研究。

Objective This study aim to compare the therapeutic benefits and complication rates of1-3minute at duration of balloon inflationin small endoscopic sphincterotomy plus large-balloon dilatation with those of less than1minute for patients with common bile duct stones.MethodsWe analyzed the clinical data of768patients with common bile duct stones.These patients underwent small endoscopic sphincterotomy pluslarge-balloon dilatation,they were divided into long duration of balloon inflation group(1-3minute)and the short duration of balloon inflation group(less than1minute).Baseline characteristics of two group,the time of cannulation and operation,complete stone removal rate,mechanical lithotripsyusage rate,complication rate(include post-endoscopic retrograde cholangiopancreatography pancreatitis rate,gastrointestinal bleeding rate,balliaryinfestion rate and perforation rate)were analyzed.Results399patients were divided into long duration of balloon inflation group,compared with369patients(short duration of balloon inflation group).There was no significant difference from baseline characteristics,time of cannulation,operation,complete stone removal rate to the mechanical lithotripsy usage rate between the long duration of balloon inflation group and the short durationof balloon inflation group.The long duration of balloon inflation group had lower rate of post-endoscopic retrograde cholangiopancreatography pancreatitis(P=0.032)and gastrointestinal bleeding compared with short duration of balloon inflation group(P=0.028).Conclusion Compared withshort duration balloon inflation,prolong the duration of balloon inflation to1-3minute reduced the overall occurence of post-endoscopic retrogradecholangiopancreatography pancreatitis and gastrointestinal bleeding,which is worth of clinical application and further discussion.