十二指肠乳头小切开+大气囊扩张治疗直径1.0～2.5 cm胆总管结石的临床分析

Small endoscopic sphincterotomy combined large-balloon dilation versus endoscopic sphincterotomy in treatment of common bile duct stones 1.0～2.5 cm in diameter

摘要:

目的  评价十二指肠乳头小切开+大气囊扩张（ESLBD）治疗直径1.0～2.5 cm胆总管结石的临床价值。方法  收集2010年6月-2014年6月该院收治的直径1.0～2.5 cm胆总管结石病例，共426例，随机分为两组，一组进行ESLBD治疗（治疗组，218例），一组进行传统十二指肠乳头大切（常规EST对照组，208例），从治疗成功率、安全性和术后临床并发症的发生情况等方面评估ESLBD治疗方法的安全性及临床价值。结果  治疗组所有结石一次性成功率为95.41%，略高于对照组，但差异无统计学意义。治疗组发生出血率为2.29%，机械碎石率为13.76%，明显低于对照组（7.69%，25.96%；P =0.025，0.002），尤其是在直径大于1.5 cm胆总管结石病例中；治疗组发生术后急性胰腺炎比例为9.17%，术后高淀粉酶血症比例为19.72%，与对照组（6.73%和18.27%）比较差异无统计学意义（P =0.452和P =0.796），两组穿孔率无差异，无死亡病例。结论  ESLBD方法治疗直径1.0～2.5 cm胆总管结石是安全可行的，相对于传统大切开治疗，能显著降低出血率和机械碎石率，不增加胰腺炎和高淀粉酶血症的比例，其并发症率低，值得临床推广。

Abstract:

Objective To evaluate the clinical efficacy of small endoscopic sphincterotomy combined large-balloon dilation in treatment of common bile duct stones 1.0～2.5 cm in diameter. Methods 426 patients with large common bile duct (CBD) stones 1.0～2.5 cm in size were reviewed in our hospital between June 2010 and June 2014. They were randomized underwent small endoscopic sphincterotomy combined large-balloon dilation (SESPLBD) (n = 218) or endoscopic sphincterotomy (EST) (n = 208) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results SESPLBD had higher complete duct clearance in one session (95.41 % vs. 93.75 %), but there was no statistical significant difference. Bleeding was much less occurred in SESPLBD than in EST (2.29 % vs. 7.69 %, P = 0.025), especially when the stones were bigger than 1.5 cm in diameter. Mechanical lithotripsy was performed less in SESPLBD (13.76 % vs 25.96 %, P = 0.002), especially when the stones were 1.5 ～ 2.0 cm in diameter. There was no statistical significant difference in the incidence rate of post-ERCP pancreatitis (9.17 % vs. 6.73 %, P = 0.452), hyperamylasemia (19.72 % vs. 18.27 %, P = 0.796), perforation and death. Conclusions SESPLBD could be a safe method for large bile duct stones 1.0～2.5 cm in size. Compared with routine EST, it had less bleeding rate and mechanical lithotripsy requirement without increasing the incidence rate of post-ERCP pancreatitis or hyperamylasemia.