括约肌切开术和乳头气囊扩张术治疗胆总管结石症的疗效比较

Comparison of the curative effect between endoscopic sphincterotomy and endoscopic papillary balloon dilatetion for the treatment of calculus of common bile duct

目的 :探讨经内镜括约肌切开术 (EST)和内镜乳头气囊扩张术 (EPBD )治疗胆总管结石的安全性和疗效 ,临床对比EST和EPBD两组近期和远期并发症。方法 :经EST和EPBD两种术式共治疗胆总管结石 72例 ,对于<10mm结石采用EPBD ,>10mm结石采用EST ,经B超及ERCP的定期随访 ,对比两者术后近期 (1个月内 )和远期 (3年内 )的疗效及并发症。结果 :治疗成功 70例占 97% ,近期并发症在EST组为 15 % ,其中出血 2例、胆管炎 3例、胰腺炎 1例 ,而EPBD组仅 1例发生胰腺炎 ,发生率为 2 9% ;远期并发症在EST组为 10 4% ,其中逆行胆总管炎 2例 ,复发性胆石症 2例 ,而EPBD组无远期并发症。结论 :EST和EPBD安全有效 ,但为更好地预防术后近、远期并发症 ,保留十二指肠乳头括约肌功能 ,对于 <10mm胆总管结石应首选EPBD ,而 >10mm胆总管结石应采用EST及相应的内镜下网篮和气囊等取石术 。

Objective To compare the safety and the curative effect between endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatetion (EPBD) for the treatment of calculus. Methods Seventy two cases with calculus of common bile duct (CBD) were studied. The stones of diameter <10 mm were treated with EST and the others with EPBD. The curative effect and the complication were observed during short term(one month)and long term(three years)follow up by B ultrasounic and ERCP. Results The success rate was 97%. The rate of the short term complication in ESTgroup was 15%, Bleeding in 2 cases, cholangitis in 3 cases, and pancreatitis in 1 caes. On the other side the note of the short term comptation was 2 9% in EPBD group, pancreatitis in 1 case; The rate of the long term complication was 10 4% in EST group,retrograde choledochitis in 2 cases, recurrent cholelthiasis in 2 cases and no long term complications occurred in EPBD group. Conclusion Both of EST and EPBD are safe and effective. In order to prevent the occurrence of the short term and the long term complication and maintain the function of duodenal papillary sphincterotomy, EPBD would be the essential choice when the diameter of stone is <10 mm. However, when the diameter of stone is >10 mm, the combination of EST and other methods should be used. Endoscopic treatment will be the essential choice for calculus of CBD.