EPLBD联合SEST治疗胆总管结石的疗效及对胆道括约肌功能的影响

EPLBD combined with SEST in the treatment of choledocholithiasis and its effect on the function of biliary sphincter

目的探讨内镜下乳头括约肌小切开联合气囊扩张术(EPLBD)联合十二指肠乳头小切开(SEST)治疗直径≥10 mm的胆总管结石近期疗效及其对胆道括约肌功能的影响。方法以结石直径≥10 mm的胆总管结石患者78例作为研究对象,随机均分为联合治疗组和对照组,对照组患者采取SEST,联合治疗组患者采取EPLBD联合SEST治疗,比较两组患者的手术效果。结果联合治疗组患者的手术时间、碎石器使用率和术后括约肌基础压、收缩压高峰值、收缩频率均显著低于对照组,一次结石取净率、术后躯体疼痛、社会功能、心理健康以及总体健康情况显著高于对照组(P<0.05)。两组之间术中出血量、胆总管直径、术后住院时间、胆总管压力和并发症情况的差异无统计学意义(P>0.05)。结论EPLBD联合SEST治疗直径≥10 mm胆总管结石疗效良好,胆道括约肌功能显著改善,生存质量有所提高,优于单一的SEST治疗。

Aim To explore the short-term curative effect of small endoscopic sphincterotomy plus large balloon dilation(EPLBD)combined with small endoscopic sphincterotomy(SEST)for the treatment of choledocholithiasis≥10 mm in diameter and its effect on biliary sphincter function.Methods In this study,78 patients with common bile duct stones diagnosed from January 2018 to January 2020 with a diameter of≥10 mm were randomly divided into observation group and control group.The control group took SEST and the observation group took EPLBD combined SEST treatment.The curative effect of the two groups was compared.Results The operation time,lithotripter usage rate,postoperativebasal pressure,peak systolic pressure and contractile frequency of the observation group were significantly lower than those of the control group,and the rate of stone removal,postoperativephysical pain,social function,mental health and overall health status were higher than those of the control group(P<0.05).There were no statistical differences in intraoperative blood loss,diameter of common bile duct,postoperative hospital stay,common bile duct pressure and complications between the two groups(P>0.05).Conclusion EPLBD combined with SEST in the treatment of choledocholithiasis with a diameter of more than 10 mm can get good curative effect,and the function of the biliary sphincter and quality of life are improved,which is better than the single SEST treatment.