三种内镜治疗方案在处理胆总管巨大结石中的疗效分析

Analysis of the efficacy of three endoscopic treatment regimens in the treatment of great calculi of common bile duct

目的:探讨三种不同治疗方案在治疗胆总管巨大结石的疗效,以进一步优化胆总管巨大结石的治疗方案。方法:回顾性分析我中心2005年至2019年胆囊切除术后因胆总管巨大结石接受内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗的患者130例,胆总管结石直径≥1.5cm,数量1~5枚不等。分为三组,其中塑料支架置入溶石(塑料支架组)70例,机械(激光)碎石(碎石组)32例,鼻胆管置入后裁切成支架(鼻胆管组)28例,分别对比患者手术时间、术后并发症、第一次住院时间、术后3个月及6个月的结石大小和支架脱落等数据,并进行统计分析。结果:碎石组的手术时间较塑料支架组和鼻胆管组的长(P<0.01);塑料支架组和鼻胆管组手术时间的比较无统计学差异(P>0.05)。碎石组的并发症发生率明显高于塑料支架组和鼻胆管组(P<0.05),主要表现在术中术后十二指肠乳头或胆道出血和术后胰腺炎。第一次住院时间在三组之间的比较无统计学差异(P>0.05)。塑料支架组和鼻胆管组在术后3个月及术后6个月结石大小和再次ERCP术取石成功率方面的比较无统计学差异(P>0.05)。结论:塑料支架置入溶石方法、机械(激光)碎石方法和鼻胆管置入后裁切成改良支架方法在处理胆总管巨大结石方面均具有安全性和有效性。相对于塑料支架置入溶石方法和鼻胆管置入后裁切成改良支架方法,机械(激光)碎石方法的手术时间较长、并发症发生率相对高,可根据患者的具体病情进行选择。

Objective:To investigate the efficacy of three different treatment regimens in the treatment of great calculi in common bile duct,so as to further optimize the treatment regimens of great calculi in common bile duct.Methods:A retrospective analysis was performed on 130 cases of choledocholithiasis treated by endoscopic retrograde cholangio panography(ERCP)after cholecystectomy in our center from 2005 to 2019.The diameter of the choledocholithiasis was≥1.5cm,and the number ranged from 1 to 5.There were three groups,including plastic stent group with plastic stent implantation(ERBD)stone(70 cases),gravel group with machinery(laser)gravel(32 cases),and nasobiliary group with nasal biliary stenting(ENBD)after cutting into stent group(28 cases).The operative time,postoperative complications,the first length of hospital stay,calculi size and stent loss 3 months and 6 months after operation were compared and analyzed respectively.Results:The operative time of the gravel group was longer than that of the plastic stent group and the nasobiliary group(P<0.01)and there was no significant difference of operation time between the plastic stent group and the nasobiliary group(P>0.05).The complication rate of the gravel group was significantly higher than that of the plastic stent group and the nasobiliary group(P<0.05),mainly manifested in intraoperative and postoperative duodenal papilla or biliary tract bleeding and postoperative pancreatitis.There was no significant difference in the first hospital stay between the three groups(P>0.05).There were no statistically significant differences between the plastic stent group and the nasobiliary group in stone size and success rate of ERCP 3 months and 6 months after surgery(P>0.05).Conclusion:Plastic stone-lysis method,mechanical(laser)lithotripsy method and modified stent-cutting method after nasobiliary duct implantation are safe and effective in the treatment of huge stones in common bile duct.Compared with the plastic stone-dissolving method and the modified stent-cutting method after nasobiliary duct implantation,the mechanical(laser)lithotriptic method has a longer operation time and a relatively high incidence of complications,which can be selected according to the specific condition of the patient.