单纯内镜乳头小球囊扩张术在胆总管较大结石中的应用效果及安全性

Effect and safety of endoscopic papillary small balloon dilation in the treatment of large calculus of common bile duct

摘要:

目的 分析内镜乳头小球囊扩张术（EPSBD）治疗胆总管较大结石（直径10～15 mm）的临床效果及安全性。方法 选择2020年1月－2023年12月该院收治的胆总管较大结石（直径10～15 mm）患者142例，采用随机数表法分为观察组与对照组，各71例。观察组行EPSBD（扩张球囊直径10 mm）治疗，对照组行内镜十二指肠乳头括约肌切开术（EST）联合球囊扩张术（EPBD）治疗。比较两组患者围手术期相关指标（取石成功率、取石时间、术后首次排便时间和住院时间），术前和术后48 h肝功能指标［总胆红素（TBiL）、谷丙转氨酶（GPT）和谷草转氨酶（GOT）］，术后早期与远期并发症的发生情况，以及术后12个月内实施腹腔镜胆囊切除术（LC）情况。结果 两组患者取石成功率、取石时间、术后首次排便时间和住院时间比较，差异均无统计学意义（P > 0.05）；术后48 h，两组患者血清TBiL、GPT和GOT水平明显低于术前，差异均有统计学意义（P < 0.05），但两组间比较，差异均无统计学意义（P > 0.05）；观察组术后早期并发症发生率为11.27%，与对照组的8.45%比较，差异无统计学意义（P > 0.05）；观察组术后远期并发症发生率为2.82%，明显低于对照组的16.90%，差异有统计学意义（P < 0.05）；术后12个月内，观察组有5例实施了LC，对照组有4例实施了LC，两组间比较，差异无统计学意义（P > 0.05）。结论 应用EPSBD治疗胆总管较大结石（10～15 mm），与EST + EPBD治疗方案相比，能获得相近的取石成功率，但前者有利于降低远期并发症的发生率。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy and safety of endoscopic papillary small balloon dilation (EPSBD) in treating large calculus of the common bile duct (diameter 10~15 mm).Methods The subjects of this study, 142 patients with large calculus of the common bile duct (10~15 mm) from January 2020 to December 2023, were divided into the observation group and the control group by the random number table method, each with 71 cases. The observation group was administered with merely EPSBD (diameter 10 mm), while the control group was used the combination of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD). The perioperative related indicators (stone removal success rate, stone removal time, time of first defecation after surgery and hospital stay), liver function indicators [total bilirubin (TBiL), glutamic-pyruvic transaminase (GPT) and glutamic-oxaloacetic transaminase (GOT)] before and 48 hours after surgery were compared between the two groups of patients, as well as the occurrence of early and long-term complications after surgery. The situation of laparoscopic cholecystectomy (LC) performed within 12 months after the operation was compared.Results There were no statistically significant differences in the success rate of stone removal, the time of stone removal, the time of first defecation after surgery and the length of hospital stay between the two groups of patients (P > 0.05). At 48 hours after the operation, the levels of serum TBiL, GPT and GOT in both groups were significantly lower than those before the operation, and the differences were statistically significant (P < 0.05). However, there were no statistically significant differences between the two groups (P > 0.05). The incidence of early postoperative complications in the observation group was 11.27%, compared with 8.45% in the control group, and the difference was not statistically significant (P > 0.05). The incidence of long-term postoperative complications in the observation group was 2.82%, significantly lower than 16.90% in the control group, and the difference was statistically significant (P < 0.05). Within 12 months after the operation, 5 cases in the observation group and 4 cases in the control group underwent LC. There was no statistically significant difference between the two groups (P > 0.05).Conclusion The application of EPSBD in the treatment of large calculus of the common bile duct (diameter 10~15 mm) can achieve a similar stone removal success rate compared with the EST + EPBD treatment regimen, but the former is more conducive to reducing the occurrence of long-term complications. It is worthy of clinical promotion and application.