经内镜乳头括约肌小切开联合球囊扩张术治疗老年胆总管结石患者的疗效与安全性分析

Efficacy and safety analysis of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in the treatment of choledocholithiasis in the elderly

目的探讨经乳头括约肌小切开联合球囊扩张术治疗老年胆总管结石的疗效与安全性。方法回顾性分析2018年1月—2019年1月因胆总管结石在郑州大学第一附属医院行内镜逆行胰胆管造影术(ERCP)治疗的≥60岁患者资料240例。按不同手术方式分为EST组和改良sEST+EPBD组。比较两组患者一般资料、取石情况、不同时间点血淀粉酶水平、术后并发症。结果选择性胆管插管成功、顺利完成ERCP手术患者230例,手术成功率为95.83%(230/240)。其中sEST+EPBD组插管成功83例,EST组插管成功147例。EST组12例因结石过大、过多一次取净困难行胆总管塑料支架置入,sEST+EPBD组25例因结石过大、过多一次取净困难行胆总管塑料支架置入。sEST+EPBD组手术时间、机械碎石率、术中出血率较EST组低(P <0.05)。sEST+EPBD组术后6 h血淀粉酶水平较EST组高(P <0.05),而术后24 h较EST组低(P <0.05)。sEST+EPBD组术后并发症总数较EST组少(P <0.05)。结论对于老年胆总管结石患者而言,sEST+EPBD术式可以更好地缩短手术时间,降低机械碎石使用率、术中出血率、术后总并发症发生率,是一种安全、有效的手术方法,具有临床推广价值。

Objective To investigate the efficacy and safety of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilation(sEST+EPBD) in the treatment of choledocholithiasis in the elderly.Methods We retrospectively analyzed the data of 240 patients over 60 years old who underwent endoscopic retrograde cholangiopancreatography(ERCP) treatment in our hospital from January 2018 to January 2019 due to choledocholithiasis. According to different surgical methods, the patients were divided into traditional endoscopic sphincterotomy(EST) group and modified sEST+EPBD group. The general information, stone removal, blood amylase before and after surgery, and postoperative complications were compared between the two groups.Results A total of 83 patients in sEST+EPBD group and 147 patients in EST group underwent successful selective bile duct cannulation and ERCP procedure, and the success rate was 95.83%(230/240). The placement of biliary plastic stent was performed in 12 patients in EST group and 25 patients in sEST+EPBD group due to oversize and overmuch stones which contributed to difficulties in one-off removal. In the cases of stone removal,the operation time in the sEST+EPBD group was shorter than that in the EST group, and the rates of mechanical lithotripsy and intraoperative bleeding in the sEST+EPBD group were lower than those in the EST group(P <0.05). The blood amylase at 6 hours after surgery was higher in the sEST+EPBD group than that in the EST group(P < 0.05), while the blood amylase at 24 hours after surgery was lower in the sEST+EPBD group than that in the EST group(P < 0.05). As for the postoperative complications, the overall complication rate of sEST+EPBD group was lower than that of EST group(P < 0.05). Conclusions For elderly patients with choledocholithiasis, sEST combined with EPBD can better shorten the operation time, reduce the rates of mechanical lithotripsy and intraoperative bleeding, and decrease the overall complication rate. Generally, sEST combined with EPBD is safe and effective, which is of value for further clinical application.