内镜下乳头括约肌小切开联合球囊扩张治疗老年胆总管结石的效果及安全性

Efficacy and safety of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilatation in the elderly with choledocholithiasis

目的探究内镜下乳头括约肌小切开术(SEST)联合球囊扩张(EPBD)治疗老年胆总管结石的效果及安全性。方法回顾性选取2015年1月至2019年10月池州市人民医院消化科收治的45例行SEST联合EPBD治疗的老年胆总管结石患者作为观察组,另选2014年1月至2018年12月本院收治的单纯行SEST治疗的患者42例作为对照组。比较两组临床资料、手术时间、术后住院时间、住院费用、取石时间、一次取石成功率、整体取石成功率及胰腺炎、淀粉酶升高、胆道出血、胆管炎等并发症发生率。结果观察组患者术后住院时间、住院费用低于对照组[(5.47±0.62)d vs.(6.03±0.75)d、(2.76±0.31)万元vs.(3.35±0.46)万元](P<0.05),两组手术时间[(112.76±14.05)minvs.(109.24±13.68)min]比较差异无统计学意义(P>0.05);观察组患者一次取石成功率高于对照组(97.78%vs.85.71%),取石时间短于对照组[(17.84±2.18)minvs.(21.06±2.37)min],差异有统计学意义(P<0.05);两组患者整体取石成功率比较差异无统计学意义(100.0%vs.100.0%,P>0.05);两组患者术后胰腺炎、淀粉酶升高发生率比较差异无统计学意义(6.67%vs.4.76%、2.22%vs.2.38%,P>0.05);而观察组胆道出血、胆管炎发生率低于对照组(2.22%vs.14.29%、4.44%vs.19.05%,P<0.05)。结论内镜下乳头括约肌小切开联合球囊扩张治疗老年胆总管结石能有效地清除胆总管结石,且并发症发生率低,是一种安全有效的治疗方法。

Objective To investigate the efficacy and safety of small endoscopic sphincterotomy(SEST)combined with endoscopic papillary balloon dilatation(EPBD)in the treatment of elderly choledocholithiasis.Methods From January 2015 to October 2019,45 patients elderly treated with choledocholithiasisby SEST and EPBD in the Department of Gastroenterology,The People's Hospital of Chizhou City were enrolled as the observation group,and another 42 patients by SSEST only in our hospital January 2014 to December 2018 were as the control group.The clinical data,operation time,postoperative hospitalization time,hospitalization cost,stone extraction time,One-time stone extraction success rate,overall stone extraction success rateas well aspancreatitis,elevated amylase,biliary bleeding,cholangitis and other complicationswere compared between the two groups.Results The postoperative hospitalization time and hospitalization cost in the observation group were lower than those in the control group[(5.47±0.62)d vs.(6.03±0.75)d,(2.76±0.31)104 yuan vs.(3.35±0.46)104 yuan](P<0.05).There was no significant difference in the operation time between the two groups(112.76±14.05 min vs.109.24±13.68 min,P>0.05).The success rate of one-time stone extraction in the observation group was higher than that in the control group(97.78%vs.85.71%),and the stone extraction time was shorter than that in the control group[(17.84±2.18)min vs.(21.06±2.37)min](P<0.05)There was no significant difference in the overall success rate of stone extraction between the two groups(100.0%vs.100.0%,P>0.05).There was no significant difference in the incidence of pancreatitis and amylase elevation in the two groups after surgery(6.67%vs.4.76%,2.22%vs 2.38%,P>0.05),but the incidenceof biliary bleeding and cholangitis in the observation group was lower than that in the control group(2.22%vs.14.29%,4.44%vs.19.05%,P<0.05).Conclusion Small endoscopic sphincterotomy and endoscopic papillary balloon dilatation for elderly choledocholithiasiss can effectively clear choledocholithiasiss with low complications,which is a safe and effective treatment method.