内镜下乳头括约肌切开术联合乳头球囊扩张治疗胆总管结石的效果观察

Effect of endoscopic sphincterotomy combined with endoscopic papillary balloon dilatation in the treatment of common bile duct stones

目的分析内镜下乳头括约肌切开术(EST)联合乳头球囊扩张(EPBD)治疗胆总管结石的临床效果。方法选取2014年8月至2016年12月侯马市人民医院收治的胆总管结石患者109例,根据治疗方法分为对照组(53例)和观察组(56例)。对照组单纯采用EST治疗,观察组采用EST^+EPBD治疗,分析比较两组患者临床治疗效果。结果观察组患者手术时间短于对照组,1次取石成功率和总取石成功率高于对照组(P<0.05)。观察组患者术后4、24h时血淀粉酶水平均低于对照组,术后24h时CD4^+和CD4^+/CD8^+水平高于对照组,CD8^+水平低于对照组(P<0.05)。对照组患者并发症率、病死率及复发率分别为26.42%、1.87%、11.32%;观察组分别为5.36%、0.00%、1.79%;观察组患者并发症率和复发率均低于对照组,差异未见统计学意义(P>0.05)。结论EST联合EPBD治疗胆总管结石取石成功率高,对机体免疫功能影响小,且并发症率和复发率低,值得临床推广应用。

Objective To analyze the clinical effect of endoscopic sphincterotomy (EST) combined with papillary balloon dilatation (EPBD) in the treatment of common bile duct stones. Methods A total of 109 patients with common bile duct stones admitted to Houma People’s Hospital from August 2014 to December 2016 were selected. According to the treatment methods, patients were divided into control group (53 cases) and observation group (56 cases). Patients in the control group were only treated with EST, while the patients in the observation group were treated by EST plus EPBD. The clinical effects of two groups were analyzed and compared. Results The operation time in observation group was shorter than in control group, and the success rate of one-time and total stone removal was higher than that of control group (P< 0.05). The serum amylase levels in the observation group after 4 h, 24 h were lower than the control group, postoperative 24 h CD4^+ and CD4^+/CD8^+ in the observation group were higher than those in the control group, the level of CD8^+ in the observation group was lower than that of the control group patients in the control group (P<0.05). The complication rate, fatality rate and recurrence rate were 26.42%, 1.87%, 11.32% respectively;those in observation group was 5.36%, 0.00%, 1.79% respectively;and the complication rate and recurrence rate in the observation group were lower than those in the control group, but there was no significant difference between the two groups (P>0.05). Conclusions EST combined with EPBD in the treatment of common bile duct stones has high success rate, small impact on immune cells, and low complication rate and recurrence rate, so it is worthy of clinical application.