单纯内镜下乳头气囊扩张在胆总管结石合并十二指肠壶腹周围憩室ERCP治疗中的应用

Application of simple endoscopic papillary balloon dilation in ERCP of choledocholithiasis with periampullary duodenal diverticula

目的:探讨单纯气囊扩张在伴有十二指肠壶腹周围憩室(PAD)的胆管结石病人ERCP治疗中的有效性和安全性。方法:回顾性分析301例经内镜逆行胆管取石病人的临床资料及操作过程,将病人分为PAD组和非PAD组,比较2组病人的基线资料、手术指标的差异;进一步将PAD组病人分为单纯气囊扩张组和括约肌切开联合气囊扩张组,比较2组的取石效果及术后并发症情况。结果:301例胆管结石病人总体PAD发生率为51.2%。PAD组和非PAD组在性别、年龄、胆总管直径、结石最大径和壶腹括约肌打开方式上比较差异均有统计学意义(P<0.01)。PAD组单纯气囊扩张实施率显著高于非PAD组(P<0.05~P<0.01)。不同憩室类型病人扩张壶腹括约肌方法差异有统计学意义,内镜下十二指肠乳头气囊扩张(EPBD)组应用金属夹预防性止血率显著低于括约肌切开术(EST)+EPBD组,胆总管直径大于EST+EPBD组(P<0.05~P<0.01)。结论:单纯气囊扩张在伴有PAD的ERCP胆管取石中安全有效,并显示出了简化操作的优势。

Objective:To explore the efficacy and safety of simple endoscopic papillary balloon dilation in ERCP treatment of choledocholithiasis with periampullary duodenal diverticula(PAD).Methods:The clinical data and therapeutic process of 301 patients undergoing endoscopic retrograde cholangiolithotomy were retrospectively analyzed.The patients were divided into PAD group and non-PAD group,and the differences of baseline characteristics and therapeutic indicators between the two groups were compared.The PAD group was further divided into the simple balloon dilation group and sphincterotomy combined with balloon dilation group,and the stone removal effect and postoperative complications of the two groups were compared.Results:The overall incidence of PAD in 301 patients with choledocholithiasis was 51.2%.There were statistically significant differences between the PAD group and non-PAD group in gender,age,diameter of the common bile duct,maximum diameter of stones,and opening method of the ampullary sphincter(P<0.05 to P<0.01).The implementation rate of simple balloon dilation in the PAD group was significantly higher than that in the non-PAD group(P<0.01).There were statistically significant differences in the methods of expanding the ampullary sphincter in patients with different diverticulum types.The rate of prophylactic hemostasis using metal clips in the EPBD group was significantly lower than that in the EST+EPBD group,and the diameter of the common bile duct was larger than that in the EST+EPBD group(P<0.05 to P<0.01).Conclusions:Simple endoscopic papillary balloon dilation is safe and effective in ERCP with PAD,and demonstrates the advantage of simplified operation.