单纯经内镜乳头大球囊扩张治疗胆总管大结石的疗效及预后研究

Curative effects and prognosis of endoscopic papillary large balloon dilatation on the treatment of choledocholithiasis

目的评估单纯经内镜乳头大球囊扩张(EPLBD)治疗胆总管大结石的疗效及预后。方法山西省人民医院2016年8月至2017年11月收治的153例胆总管大结石(结石直径>1.0 cm)患者按随机数字表法随机分为两组:EPLBD组(n=83例)和经内镜乳头小切开联合大球囊扩张(ESLBD)组(n=70例),比较两组患者的取石成功率,术中碎石率,术后近期并发症发生率及远期结石复发率。结果EPLBD组和ESLBD组在总的、一次性结石取尽率方面差异无统计学意义[95.2%(79/83)比97.1%(68/70),χ^2=0.388,P=0.533;92.8%(77/83)比90.0%(63/70),χ^2=0.375,P=0.540]。EPLBD组碎石使用率与ESLBD组比较差异无统计学意义[25.3%(21/83)比35.7%(25/70),χ^2=1.958,P=0.162]。两组近期并发症发生率比较差异无统计学意义[43.4%(36/83)比40.0%(28/70),χ^2=0.178,P=0.673];两组均无术后穿孔病例。EPLBD组随访时间(22.7±4.3)个月,ESLBD组为(20.8±6.3)个月,两组胆总管结石累积复发率差异有统计学意义[2.4%(2/83)比15.7%(11/70),P=0.003]。结论EPLBD治疗胆总管大结石在取石成功率、碎石使用率、近期并发症发生率方面与ESLBD相当,远期结石复发率低于后者。单纯EPLBD治疗胆总管大结石安全有效。

Objective To evaluate the curative effect and prognosis of endoscopic papillary large balloon dilatation (EPLBD) in the treatment of choledocholithiasis. Methods A total of 153 patients with choledocholithiasis (>1.0 cm in stone diameter) admitted and treated in Shanxi People′s Hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table: the EPLBD group (n=83) and the small endoscopic sphincterotomy plus large balloon dilatation (ESLBD) group (n=70). The success rate of stone removal, the rate of lithotripsy, and the incidence of short-term and long-term complications were compared between the two groups. Results There were no statistical differences between the EPLBD group and the ESLBD group in total stone removal rate [95.2%(79/83) VS 97.1%(68/70),χ^2=0.388, P=0.533] and one-time stone removal rate [92.8%(77/83) VS 90.0%(63/70),χ^2=0.375, P=0.540]. The lithotripsy rate between the two groups had no statistical difference [25.3%(21/83) VS 35.7%(25/70),χ^2=1.958, P=0.162]. There was no statistical difference in the incidence of recent complications between the two groups [43.4%(36/83) VS 40.0%(28/70),χ^2=0.178, P=0.673]. No postoperative perforation was found in either group. The follow-up time was 22.7±4.3 months in the EPLBD group, and 20.8±6.3 months in the ESLBD group.The cumulative recurrent rate of choledocholithiasis in the two groups were 2.4%(2/83) and 15.7%(11/70), respectively, and the difference was significant (P=0.003). Conclusion Simple EPLBD in the treatment of choledocholithiasis is equivalent to ESLBD in the success rate of stone removal, utilization rate of lithotripsy, and incidence of recent complications, but the long-term stone recurrence rate of EPLBD is lower than that of ESLBD. EPLBD is effective and safe on the treatment of choledocholithiasis.