内镜下乳头括约肌小切开术联合内镜下乳头球囊扩张术治疗老年胆总管结石合并急性胆管炎患者的临床效果

Clinical efficacy of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilatation for treatment of elderly choledocholithiasis patients complicated with acute cholangitis

目的探讨内镜下乳头括约肌小切开术(sEST)联合内镜下乳头球囊扩张术(EPBD)治疗老年胆总管结石合并急性胆管炎患者的疗效。方法将105例老年胆总管结石合并急性胆管炎患者随机分为单纯内镜下乳头括约肌切开术(EST)组(35例)、EPBD组(32例)与sEST+EPBD组(38例)。EST组采用内镜下逆行胰胆管造影术(ERCP)+EST治疗,EPBD组采用ERCP+EPBD治疗,sEST+EPBD组采用ERCP+sEST+EPBD治疗。比较3组患者单次取石成功率、术后相关指标及并发症发生情况。结果3组患者单次取石成功率、术后12 h的腹痛缓解率、体温正常率、白细胞正常率、术后1周的直接胆红素正常率、ALP正常率,以及术后住院时间、反流性胆管炎发生率及结石复发率比较,差异均无统计学意义(均P>0.05),但sEST+EPBD组术中出血、术后高淀粉酶血症及ERCP术后胰腺炎(PEP)的发生率均低于EPBD组与EST组(均P<0.05)。结论ERCP+sEST+EPBD治疗老年胆总管结石合并急性胆管炎患者疗效确切,安全性高,并可降低术中出血、PEP及高淀粉酶血症的发生率。

Objective To investigate the efficacy of small endoscopic sphincterotomy(sEST)combined with endoscopic papillary balloon dilatation(EPBD)for the treatment of elderly choledocholithiasis patients complicated with acute cholangitis.Methods A total of 105 elderly patients with choledocholithiasis complicated with acute cholangitis were randomly divided into endoscopic sphincterotomy(EST)group(35 cases),EPBD group(32 cases)and sEST+EPBD group(38 cases).The EST group received endoscopic retrograde cholangiopancreatography(ERCP)and EST,the EPBD group received ERCP and EPBD,and the sEST+EPBD group received ERCP+sEST+EPBD.The success rate of single stone removal,postoperative relevant indexes,and incidence of complications were compared among the three groups.Results There were no statistically significant differences among the three groups in success rate of single stone removal,abdominal pain relief rate,normal body temperature rate and normal WBC rate 12 hours after operation,normal direct bilirubin rate and normal ALP rate one week after operation,postoperative hospital stay,incidence rate of reflux cholangitis,or recurrence rate of stones(all P>0.05).However,the sEST+EPBD group had lower incidence rates of intraoperative bleeding,postoperative hyperamylasemia and post-ERCP pancreatitis(PEP)than the EPBD and EST groups(all P<0.05).Conclusion ERCP+sEST+EPBD has a definite efficacy and high safety for elderly choledocholithiasis patients complicated with acute cholangitis,and can reduce the incidence rates of intraoperative bleeding,PEP and hyperamylasemia.