Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involv...Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significant difference at 1 year after the procedure, but the EPBD group had significantly higher levels at 1 week following the procedure. Conclusion:In this study it was found that in patients with CBD stones both EPBD and EST preserve sphincter of Oddi function.展开更多
目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆...目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石的效果及对患者炎症因子水平的影响。方法:选取2019年1月—2021年12月福建医科大学附属龙岩第一医院收治的176例胆囊结石合并胆总管结石患者作为研究对象,用随机数表法将其分为对照组和观察组,各88例。对照组接受EST+LC治疗,观察组接受LC+LCBDE治疗,比较两组疗效、围手术期指标、炎症因子、并发症等。结果:观察组一次性结石清除率为94.32%,低于对照组的95.45%,但差异无统计学意义(χ^(2)=0.1171,P>0.05)。观察组治疗费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异均有统计学意义(t=4.9958、46.0574、24.1632,P<0.05);但两组首次下床活动时间、术中出血量比较,差异均无统计学意义(t=0.0000、0.0628,P>0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、C反应蛋白(CRP)比较,差异无统计学意义(t=0.0061、0.0092、0.3235,P>0.05);观察组TNF-α、IL-8、CRP均低于对照组,差异均有统计学意义(t=6.4203、8.2981、39.5606,P<0.05)。观察组并发症发生率为2.27%,低于对照组的3.41%,但差异无统计学意义(χ^(2)=0.2058,P>0.05)。结论:LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的效果相当,但前者炎症因子水平更低、住院时间更短,临床可根据患者实际状况综合确定治疗方式。展开更多
胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ER...胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、经内镜Oddi括约肌切开术(endoscopic sphincterotomy,EST)或经内镜十二指肠乳头切开术[1,2],现将武警安徽总队医院1 268例胆总管结石的治疗体会加以总结和分析。展开更多
文摘Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significant difference at 1 year after the procedure, but the EPBD group had significantly higher levels at 1 week following the procedure. Conclusion:In this study it was found that in patients with CBD stones both EPBD and EST preserve sphincter of Oddi function.
文摘目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石的效果及对患者炎症因子水平的影响。方法:选取2019年1月—2021年12月福建医科大学附属龙岩第一医院收治的176例胆囊结石合并胆总管结石患者作为研究对象,用随机数表法将其分为对照组和观察组,各88例。对照组接受EST+LC治疗,观察组接受LC+LCBDE治疗,比较两组疗效、围手术期指标、炎症因子、并发症等。结果:观察组一次性结石清除率为94.32%,低于对照组的95.45%,但差异无统计学意义(χ^(2)=0.1171,P>0.05)。观察组治疗费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异均有统计学意义(t=4.9958、46.0574、24.1632,P<0.05);但两组首次下床活动时间、术中出血量比较,差异均无统计学意义(t=0.0000、0.0628,P>0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、C反应蛋白(CRP)比较,差异无统计学意义(t=0.0061、0.0092、0.3235,P>0.05);观察组TNF-α、IL-8、CRP均低于对照组,差异均有统计学意义(t=6.4203、8.2981、39.5606,P<0.05)。观察组并发症发生率为2.27%,低于对照组的3.41%,但差异无统计学意义(χ^(2)=0.2058,P>0.05)。结论:LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的效果相当,但前者炎症因子水平更低、住院时间更短,临床可根据患者实际状况综合确定治疗方式。
文摘胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、经内镜Oddi括约肌切开术(endoscopic sphincterotomy,EST)或经内镜十二指肠乳头切开术[1,2],现将武警安徽总队医院1 268例胆总管结石的治疗体会加以总结和分析。
