EPLBD术治疗老年胆总管结石的效果及对血淀粉酶的影响

Effect of EPLBD on Blood Amylase of Elderly Patients with Choledocholithiasis

目的探讨内镜下乳头括约肌小切开联合气囊扩张术(EPLBD)治疗老年胆总管结石的效果及对血淀粉酶的影响。方法选取南阳市第一人民医院2016年1月~2017年12月期间收治的100例老年胆总管结石患者,按照随机数字法分为两组,每组各50例。对照组予以内镜下乳头括约肌切开术取石,研究组予以EPLBD取石。比较两组患者操作时间、机械碎石率、首次取石成功率、急性胰腺炎发生率、术后大出血发生率、高淀粉酶血症发生率以及术前、术后3h、12h、24h时血淀粉酶水平。结果研究组操作时间显著少于对照组操作时间,两组比较差异有统计学意义(P<0.05),研究组机械碎石率显著低于对照组(P<0.05)。两组间首次取石成功率、并发症发生率比较无显著性差异(P<0.05),两组患者术前、术后3h、12h、24h血淀粉酶水平比较无显著差异(P<0.05)。结论 EPLBD治疗老年胆总管结石具有较高的首次取石成功率,不会增加并发症发生率,需行机械碎石术几率低,是一种安全有效的方式,值得在临床上推广使用。

Objective To investigate the effect of endoscopic sphincterotomy combined with balloon dilatation(EPLBD)on the treatment of choledocholithiasis in the elderly and the effect on the blood amylase.Methods 100 cases of senile choledocholithiasis in the Nanyang First People’s Hospital from January 2016 to December 2017 were selected and randomly divided into 2 groups according to the random number method,50 cases in each group.In the control group,50 cases were performed endoscopic sphincterotomy,while 50 patients in the study group were treated with EPLBD.The time of operation,the rate of mechanical lithotripsy,the success rate of the first stone extraction,the incidence of acute pancreatitis,the incidence of massive hemorrhage,the incidence of hyperamylacemia,and the level of blood amylase at 3h,12h and 24h after operation were compared between the two groups.Results The operation time of the study group was significantly less than that of the control group,and the difference between the two groups was statistically significant(P<0.05),and the mechanical crushed stone rate of the study group was significantly lower than that of the control group(P<0.05).There was no significant difference(P<0.05)among the two groups.There was no significant difference between the two groups(P<0.05)before and after the operation,and there were no significant differences in the levels of 3h,12h and 24h before and after operation.Conclusion EPLBD in the treatment of old choledocholithiasis has a high success rate for the first time.It will not increase the incidence of complications.It is a safe and effective way,which is worth to be used in clinical practice.