不同直径EPLBD治疗胆总管结石的安全性

SAFETY OF ENDOSCOPIC PAPILLARY LARGE BALLOON DILATATION WITH DIFFERENT DIAMETERS IN THE TREATMENT OF CHOLEDOCHOLITHIASIS

目的探讨不同直径内镜下十二指肠乳头大气囊扩张术(EPLBD)治疗胆总管结石的安全性。方法回顾性分析2013年1月—2018年6月在我院行EPLBD治疗的343例胆总管结石病人,根据气囊扩张直径,将病人分为较小气囊组(12.0~13.5 mm组)、中等大小气囊组(15.0~16.5 mm组)和较大气囊组(18.0~20.0 mm组)。比较各组病人的治疗情况、近期并发症及结石复发情况。结果总取石成功率为99.7%。各组机械碎石使用率差异有统计学意义(χ^(2)=22.700,P<0.05),机械碎石使用率的线性趋势差异也具有统计学意义(χ^(2)=19.133,P<0.05)。各组术后胰腺炎、出血、穿孔、胆管炎发生率以及结石复发率比较,差异均无统计学意义(P>0.05)。结论不同直径EPLBD治疗胆总管结石是安全的。随着结石直径的增大,即使采用更大直径的气囊扩张,需要采取碎石技术的可能性也增大。

Objective To investigate the safety of endoscopic papillary large balloon dilatation(EPLBD)with different diameters in the treatment of choledocholithiasis.Methods A retrospective analysis was performed for the clinical data of 343 patients with choledocholithiasis who were treated by EPLBD in our hospital from January 2013 to June 2018,and according to the diameter of balloon dilation,the patients were divided into small balloon group(12.0-13.5 mm),medium balloon group(15.0-16.5 mm),and large balloon group(18.0-20.0 mm).The three groups were compared in terms of treatment,short-term complications,and calculus recurrence.Results The overall success rate of stone removal was 99.7%.There was a significant diffe-rence in the rate of use of mechanical lithotripsy between groups(χ^(2)=22.700,P<0.05),and there was also a significant differences in the linear trend of the rate of use of mechanical lithotripsy between groups(χ^(2)=19.133,P<0.05).There were no significant differences in the incidence rates of postoperative pancreatitis,bleeding,perforation,and cholangitis and calculus recurrence rate between groups(P>0.05).Conclusion EPLBD with different diameters is safe in the treatment of choledocholithiasis.With the increase in stone diameter,the possibility for the use of mechanical lithotripsy increases even if a larger balloon is used for dilation.