乳头括约肌小切开术联合气囊扩张与传统乳头括约肌切开术治疗胆总管结石的效果比较

Small endoscopic sphincterotomy combined with balloon dilatation versus conventional endoscopic sphincterotomy in the treatment of choledocholithiasis

目的比较乳头括约肌小切开术(SEST)联合气囊扩张(EPBD)与传统乳头括约肌切开术(EST)取石治疗胆总管结石的效果.方法采用随机数字表法将68例胆总管结石患者分为观察组与对照组,各34例.观察组患者行SEST联合EPBD术,对照组行传统EST术.比较2组患者的临床治疗效果、取石情况、手术前后血清淀粉酶水平及并发症生情况.结果观察组治疗总有效率为94.12%,对照组治疗总有效率为70.59%,差异有统计学意义(P<0.05);观察组患者的取石时间显著短于对照组,一次取石成功率显著高于对照组,机械碎石率和复发率显著低于对照组,差异有统计学意义(P<0.05),2组复发时间比较无统计学差异(P>0.05);术前2组患者血清淀粉酶水平比较无统计学差异(P>0.05),术后3h和术后24h观察组血清淀粉酶水平均显著低于低对照组,差异有统计学意义(P<0.05);观察组患者的并发症发生率显著低于对照组,差异有统计学意义(P<0.05).结论SEST联合EPBD治疗胆总管结石的取石成功率和临床总有效率高,对血清淀粉酶水平影响较小,并发症发生率低,且能显著降低复发率并缩短取石时间.

Objective To compare the efficacy of small endoscopic sphincterotomy(SEST)combined with endoscopic papillary balloon dilatation(EPBD)and conventional endoscopic sphincterotomy(EST)in the treatment of choledocholithiasis.Methods A total of 68 patients with choledocholithiasis admitted to our hospital were divided into two groups by random number table method,with 34 cases in each group.The observation group was given SEST combined with EPBD,while the control group performed conventional EST.The clinical therapeutic effect,stone extraction,serum amylase levels before and after surgery and incidence of complications were compared between the two groups.Results The total effective rate in the observation group was 94.12%,and was 70.59%in the control group,and a significant difference was seen between groups(P<0.05).The stone removal time of the observation group was significantly shorter,the success rate of the first stone removal was significantly higher,and the rates of mechanical lithotripsy and recurrence were significantly lower than that of the control group(P<0.05).There was no statistical difference in the recurrence time between the two groups(P>0.05).No significant difference in serum amylase levels between the two groups before surgery were found(P>0.05),but its levels were significantly lower in the observation group at 3,and 24 h after surgery than that in the control group(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion SEST combined with EPBD has higher efficacy in success rate and clinical total effective rate,and has little effect on serum amylase level,can reduce the incidence of complications and recurrence rate,and shorten time of stone extraction.