内镜下不同大小气囊十二指肠乳头扩张术治疗胆总管结石的近期疗效*

Short term effect of different diameters of ampulla balloon dilation in treatment of choledocholithiasis*

摘要:

目的??探讨内镜下不同直径大小气囊十二指肠乳头扩张术（EPBD）治疗胆总管结石的近期疗效。方法?将上海市浦东新区公利医院普外科2015年1月-2015年10月连续收治的80例胆总管结石患者作为研究对象，根据胆总管结石大小分别采用直径8、10、12和14 mm的气囊扩张，相应将胆总管结石患者分成4组，分别为8 mm组、10 mm组、12 mm组和14 mm组。然后采用取石网篮取石、取石球囊取石，必要时行机械碎石。观察各组患者术后24 h出血、急性胰腺炎、高淀粉酶血症和肠穿孔的发生情况；术后2周行上腹部CT、胃肠造影检查，观察各组患者胆道积气、胆总管返流发生情况，分析比较不同组之间的近期疗效。结果?各组患者均在EPBD下取石成功，取石成功率100.0%，各组间出血、穿孔、急性胰腺炎和高淀粉酶血症差异无统计学意义（P >0.05）；而在术后2周胆道积气和胆总管返流差异具有统计学意义（P <0.05）。结论?EPBD是一种安全有效的胆总管取石方法，随气囊直径增加，对Oddi括约肌功能影响可能越大。

Abstract:

Objective?To investigate the short term efficacy and security of different diameters of ampulla balloon dilation in the treatment of choledocholithiasis.?Methods?80 patients with extrahepatic bile duct stones treated by EPBD were included in this study. All the patients were divided into 8 mm group, 10 mm group, 12 mm group, 14 mm group, which were according to the diameter of common bile duct (CBD) and stones. CBD stones were removed with retrieved balloon, Dormia basket, and/or mechanical lithotripsy if necessary. The incidence of 24 h hemorrhage, acute pancreatitis, hyperamylasemia and intestinal perforation were observed, and the incidence of pneumobilia and duodenobiliary reflux two weeks after EPBD. Then analyzed the short-term efficacy of the four groups.?Result?The overall success of stone removal in all groups were 100.0%, there was no significant differences in bleeding, intestinal perforation, hyperamylasemia, pancreatitis between each group (P > 0.05) . There shows significant differences in pneumobilia and duodenobiliary reflux two weeks after EPBD (P < 0.05). The incidence of pneumobilia and duodenobiliary reflux increased with the size of the balloon.?Conclusion?The application of EPBD is effective and safe for bile duct stone removal, while with the increasing of balloon diameter, the function of Oddi sphincter has severely influenced.