乳头小切开联合EPBD治疗胆总管结石的临床研究

A Clinical Study of Limited Endoscopic Sphincterotomy Combined with Balloon Dilatation in the Treatment of Choledocholithiasis

目的 探讨内镜下乳头括约肌小切开联合球囊扩张术治疗直径≥10mm的胆总管结石的安全性及有效性。方法选取2016年1月~2020年12月于笔者医院消化内科住院的胆总管结石直径≥10mm的患者152例,其中内镜下乳头括约肌切开术组(EST组)51例、内镜下乳头球囊扩张术组(EPBD组)51例和内镜下乳头括约肌小切开联合球囊扩张术组(ESBD组)50例。对3组的一次性结石清除率、机械碎石使用率、ERCP插管后手术时间、术后早期并发症的发生率进行比较分析。结果 152例患者中,133例(87.5%)一次性取尽结石,17例二次ERCP取尽结石,1例残留结石较小(直径4mm)术后自行排出,1例结石巨大(直径23mm)转外科手术取石。ESBD组一次性结石清除率优于EST组和EPBD组(P=0.013);机械碎石使用率与EST组比较,差异无统计学意义(P=0.204),低于EPBD组(P=0.041);ERCP插管后手术时间,3组比较差异无统计学意义(P=0.105)。术后早期并发症方面,ESBD组胰腺炎和胆管炎的发生率低于EST组和EPBD组(P值分别为0.044、0.032);EST组出血和穿孔发生率分别为2.0%和3.9%,高于EPBD组和ESBD组(均为0),无法进行统计比较。结论 胆总管较大结石(直径≥10mm)ERCP手术方式中,ESBD较EST和EPBD,有较高的一次性结石清除率和较低的机械碎石使用率,且术后早期并发症发生率低,在临床上收到了良好的效果,值得广泛推广。

Objective To investigate the safety and efficacy of limited endoscopic sphincterotomy combined with balloon dilation in the treatment of common bile duct stones with diameterct ston.Methods From January 2016 to December 2020,152 patients with choledocholithiasis diameterolithiasis diameterr 2020,152 patients with choledocholithiasis diametered wi There were 51 cases in EST group,51 cases in EPBD group,and 50 cases in ESBD group.One-time stone clearance rate,utilization rate of mechanical gravel,operation time after ERCP intubation and incidence of short-term postoperative complications were compared and analyzed among the three groups.Results Among 152 patients,133 patients(87.5%) had all the stones removed at one time,17 patients had all the stones removed by ERCP twice,1 patient had small residual stones(4 mm in diameter) discharged spontaneously after surgery,1 patient had large stones(23 mm in diameter) transferred to surgical stone removal,and 30 patients(19.7%) had short-term postoperative complications,including 19 cases of acute pancreatitis,1 case of bleeding,2 cases of perforation and 8 cases of cholangitis.One-time stone clearance rate in ESBD group was better than that in EST group and EPBD group(P=0.013).The utilization rate of mechanical gravel was similar to that of EST group(P=0.204),but lower than that of EPBD group(P=0.041).There was no significant difference in operation time after ERCP intubation among them(P=0.105).In terms of short-term postoperative complications,the incidence of pancreatitis and cholangitis in ESBD group was lower than that in EST group and EPBD group(P were 0.044,0.032).The incidences of bleeding and perforation in EST group were 2.0% and 3.9%,respectively,higher than that in EPBD group and ESBD group(each incidence was 0),which could not be statistically compared.Conclusion In ERCP surgery for large common bile duct stones(diameterernce w compared with EST and EPBD,ESBD has a higher one-time stone clearance rate and a lower utilization rate of mechanical gravel,and has a lower incidence of short-term postoperative complications.Therefore,it has received good clinical results and is worthy of widespread promotion.