内镜下十二指肠乳头括约肌球囊扩张术与联合乳头括约肌切开术治疗胆总管结石疗效比较

Endoscopic papillary balloon dilation for the treatment of common bile duct stones

目的分析比较单纯行内镜下十二指肠乳头括约肌球囊扩张术(EPBD)与内镜下乳头括约肌切开术(EST)+EPBD治疗胆总管结石的疗效及安全性。方法选取杭州市第一人民医院2016年1月至2019年12月收治的行内镜下乳头球囊扩张治疗胆总管结石患者411例。根据手术方法分为EPBD组(118例)和EST+EPBD组(293例),比较两组基本资料包括胆道情况、术中取石情况,观察有无术后并发症,包括术后胰腺炎、出血(术中出血和术后出血)、感染、术后穿孔、死亡情况。结果两组患者取石成功率、一次净石率、手术时间比较差异均无统计学意义(均P>0.05);但EPBD组机械碎石率明显高于EST+EPBD组,差异有统计学意义(P<0.05)。EST+EPBD组患者总出血、术中出血发生率均明显高于EPBD组,差异均有统计学意义(均P<0.01)。结论EPBD治疗胆总管结石安全有效,但联合EST会增加术后出血的发生率,EPBD治疗胆总管结石效果可能优于EST+EPBD。

Objective To investigate the efficacy and safety of endoscopic papillary balloon dilation(EPBD)and endoscopic sphincterotomy EPBD for treatment for common bile duct stones.Methods Clinical data of 411 patients with common bile duct stones admitted in Hangzhou Red Cross Hospital from January 2016 to December 2019 were collected,including 118 receiving EPBD and 293 patients receiving endoscopic minor sphincterotomy(EST)+EPBD.The efficacy and adverse events of two group were compared.Results There was no significant difference in the overall success rate,initial success rate and procedure time(P>0.05).The use of mechanical lithotripsy was more frequent in EPBD group(P=0.001).There was no significant difference in incidence of pancreatitis between two groups(P>0.05),however,the postoperative bleeding occurred more frequently in EST+EPBD group(P=0.002).Conclusion EPBD is safe and feasible for the treatment of common bile duct stones.EST+EPBD may increase the incidence of postoperative bleeding.