内镜下乳头大气囊扩张术对并发憩室胆总管结石效果

CLINICAL EFFECT OF ENDOSCOPIC PAPILLARY LARGE BALLOON DILATATION IN TREATMENT OF PERIAMPULLARY DIVERTICULA IN PATIENTS WITH CHOLEDOCHOLITHIASIS

目的探讨内镜下乳头大气囊扩张术(EPLBD)治疗并发壶腹周围憩室(PAD)胆总管结石病人的效果和安全性。方法收集2013年1月—2018年1月行EPLBD治疗胆总管结石508例病人临床资料并进行回顾性分析,比较有憩室组(PAD组)和无憩室组(N-PAD组)病人的一般资料、治疗情况、术后并发症及结石复发情况。结果 N-PAD组病人193例,PAD组病人315例,两组取石成功率、短期并发症(胰腺炎、出血、穿孔、胆管炎)发生率比较差异无统计学意义(P>0.05);N-PAD组结石复发率(17.1%)高于PAD组(9.3%),差异有显著性(χ^(2)=4.423,P<0.05)。按憩室大小分组,小憩室组术后急性胰腺炎的发生率(9.5%)高于大憩室组(0)及中憩室组(3.0%),差异有统计学意义(χ^(2)=9.973,P<0.01);按Boix分型,不同类型的憩室并发症发生率差异无统计学意义(P>0.05);不同类型和不同大小的憩室病人的结石复发率比较差异无显著性(P>0.05)。结论 PAD不增加EPLBD治疗胆总管结石的风险,憩室不增加EPLBD术后结石的复发。

Objective To investigate the effect and safety of endoscopic papillary large balloon dilatation(EPLBD)in the treatment of periampullary diverticula(PAD)in patients with choledocholithiasis.Methods A retrospective analysis was performed for the clinical data of 508 patients with choledocholithiasis who underwent EPLBD from January 2013 to January 2018,and general information,treatment,postoperative complications,and recurrence of calculi were compared between the patients with PAD(PAD group)and those without PAD(N-PAD group).Results There were 193 patients in the N-PAD group and 315 patients in the PAD group.There were no significant differences in the success rate of lithotomy and the incidence rates of short-term complications(pancreatitis,hemorrhage,perforation,and cholangitis)between the two groups(P>0.05),and the N-PAD group had a significantly higher recurrence rate of calculi than the PAD group(17.1%vs 9.3%;χ^(2)=4.423,P<0.05).The patients with PAD were divided into groups according to the size of PAD;the small PAD group had a significantly higher incidence rate of postoperative acute pancreatitis than the large PAD group and the middle PAD group(9.5%vs 0/3.0%;χ^(2)=9.973,P<0.01).According to Boix classification,there were no significant differences in the incidence rates of complications between the patients with different types of diverticula(P>0.05).There was no significant difference in the recurrence rate of calculi between the patients with different types and sizes of diverticula(P>0.05).Conclusion PAD does not increase the risk in the treatment of choledocholithiasis by EPLBD or the recurrence rate of choledocholithiasis after EPLBD.