内镜下乳头括约肌切开术与球囊扩张术治疗 胆总管结石的临床对照研究

A comparative study of endoscopic sphincterotomy versus endoscopic papillary balloon dilatation in the treatment of choledocholithiasis

摘要:

目的 比较内镜下十二指肠乳头扩约肌切开术（endoscopic sphincterotomy，EST）与十二指肠乳头括约肌球囊扩张术（EPBD）治疗胆石症的安全性和有效性。 方法 329例经内镜下行EST或EPBD治疗的胆石症患者纳入该研究。比较及评价指标包括结石完全清除率、术后相关并发症发生率及其危险因素等。 结果 在EST组和EPBD组中结石完全清除率分别为93.2%和95.9%（P =0.304）；EST组和EPBD组对于直径<1 cm结石清除率均显著高于直径≥1 cm结石者（P 值分别为0.001与0.025）；EST组与EPBD组总体并发症发生分别为7.3%和12.7%（P =0.112）；EPBD组术后胰腺炎发生率显著高于EST组（10.2% VS 4.2%，P =0.037）；所有20例术后胰腺炎均为轻度胰腺炎。EPBD操作及胰管内插管或注射造影均是发生术后胰腺炎的危险因素。 结论 内镜下EST与EPBD治疗胆石症的安全性及有效性相似。胰管插管或胰管内注射造影是EST或EPBD术后发生胰腺炎的危险因素。EPBD操作简单，对于直径<1 cm结石者，尤其年老体弱、有凝血功能障碍或需抗凝治疗者，EPBD是一个更好的治疗之选。

Abstract:

【Objective】 To compare the efficacy and safety of EST and EPBD in the treatment of choledocholithiasis. 【Methods】 329 patients with bile duct stones were enrolled. The rates of successful stone removal, postoperative complications, related risk factors and so on in EST and EPBD were compared and evaluated. 【Results】 The rates of successful stone removal in EST and EPBD were 93.2% VS 95.9% , respectively(P =0.304). Clearance rates of stones <1 cm were significantly higher than stones ≥1 cm both in EST and EPBD (P =0.001 and 0.025, respectively). The rates of overall complications in EST and EPBD were 7.3% , 12.7% respectively (P =0.112); EPBD had a significantly higher incidence of postoperative pancreatitis than EST(10.2% VS 4.2%, P =0.037). All 20 cases of postoperative pancreatitis were mild pancreatitis. The procedure of EPBD and pancreatic duct intubation or injection were risk factors for postoperative pancreatitis. 【Conclusion】 The efficacy and safety of EST and EPBD in the treatment of choledocholithiasis were similar. Intubation or injection of the pancreatic duct were risk factors for postoperative pancreatitis. The procedure of EPBD is simple for stones <1 cm, especially safer for elderly, patients with blood coagulation dysfunction or requiring anti-coagulation treatment, EPBD was superior.