乳头柱状球囊扩张术时间的选择及其对胆总管结石疗效的影响

Effect of Different Duration of Papillary Balloon Dilatation on the Treatment of Common Bile Duct Stones

目的 探讨乳头柱状球囊扩张术(EPBD)治疗时间的选择及其对内镜逆行胰胆管造影(ERCP)治疗胆总管结石疗效的影响。方法 选取2017年1月至2022年12月于青岛市胶州中心医院住院治疗的108例胆总管结石患者作为研究对象,将EPBD持续时间为30 s的患者列入30 s组,将EPBD持续时间为60 s的患者列入60 s组,两组各54例。两组均行ERCP取石,记录两组性别、年龄、憩室旁乳头比率、结石直径、胆管直径等一般资料,一次净石率、机械碎石率、术中活动性出血率、手术时间、住院时间等取石情况,穿孔、术后出血、急性胰腺炎、高淀粉酶血症等术后并发症发生情况。比较两组患者的临床资料,建立不同EPBD持续时间ERCP治疗胆总管结石的多准则决策模型。结果 60 s组患者的一次净石率高于30 s组(P<0.05),机械碎石率、住院时间、住院费用、术后并发症的发生率均低于30 s组(P<0.05)。应用Meta分析方法分别合并两组患者的风险-效益值发现,60 s组的效益平均值、风险平均值均高于30 s组,且效益-风险总值68高于30 s组的58;60 s组优于30 s组的概率为100%。结论 选择EPBD时间维持在60 s可有效提高一次净石率,降低机械碎石率、住院时间及住院费用,减少急性胰腺炎和高淀粉酶血症的发生。

Objective To explore the effect of different duration of balloon dilatation in endoscopic papillary balloon dilatation(EPBD)on the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of common bile duct(CBD)stones.Methods A total of 108 patients with CBD stones hospitalized in Jiaozhou Central Hospital of Qingdao between January 2017 and December 2022 were selected as the study subjects.They were divided into a 30 s group(n=54)and a 60 s group(n=54)according to their duration of balloon dilatation when undergoing ERCP for stone removal.General data such as gender composition,age,ratio of papillae adjacent to diverticulum,stone diameter and bile duct diameter,the situation realted to stone removal such as one-time stone clearance rate,mechanical lithotripsy rate,intraoperative active bleeding rate,duration of operation,and hospital stay,and the occurrence of postoperative complications such as perforation,postoperative bleeding,acute pancreatitis,and hyperamylasemia were recorded.The clinical data were compared between two groups.A multi-criteria decision-making model for ERCP with different duration of balloon dilatation in the treatment of CBD stones was established.Results Compared with the 30 s group,the 60 s group had higher one-time stone clearance rate(P<0.05),but lower mechanical lithotripsy rate,shorter hospital stay,less hospital expenses,and lower incidence of postoperative complications(P<0.05).Meta analysis was used to combine the risk-benefit values of the two groups.It was found that both the average benifit value and the average risk value in the 60 s group were higher than those in the 30 s group.The total benefit risk value in the 60 s group was 68,which was higher than 58 in the 30 s group.And the probability that the 60 s group was better than the 30 s group was 100%.Conclusion In the removal of CBD stones by ERCP,EPBD with 60 s duration of balloon dilatation can effectively improve the one-time stone clearance rate,reduce the mechanical lithotripsy rate,hospital stay,hospital expenses,and incidence of acute pancreatitis and hyperamylasemia.