乳头括约肌小切开联合大气囊扩张在 肝外胆管大结石内镜治疗中的作用

Minor endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation for extrahepatic bile duct stones

摘要:

目的 探讨乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中的安全性及有效性。方法 87例肝外胆管结石直径≥1.0 cm患者采用奇偶数法分为两组，奇数组43例接受乳头括约肌小切开联合大气囊扩张术取石治疗，偶数组44例接受乳头括约肌切开取石治疗，比较两组间结石取净率、取石次数、机械碎石率、结石嵌顿率、操作时间及早期并发症发生情况。结果 观察组4例出现高淀粉酶血症，3例出现轻症急性胰腺炎，并发症发生率为16.3%（7/43）；对照组中，有3例出现高淀粉酶血症，2例出现轻症急性胰腺炎，3例出血，并发症发生率为18.2%（8/44），差异无显著性（P >0.05），但出血率比较差异有显著性（P <0.05）。观察组结石取净率、结石嵌顿率、机械碎石率、二次取石率、操作时间分别为97.7%（42/43）、0%（0/43）、4.6%（2/43）、0%（0/43）及（35.2±5.2）min；对照组对应为97.7%（43/44）、6.8%（3/44）、18.1%（8/44）、13.6%（6/44）及（45.1±4.0）min，除结石取净率比较差异无显著性（P >0.05），其他4项比较差异均有显著性（P <0.05）。结论 乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中安全有效，操作简便。

Abstract:

【objective】 To evaluate the effects and the safety of endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD) in the treatment of extrahepatic bile duct stones. 【Methods】 A total of 87 patients with extrahepatic bile duct stones were divided into 2 groups to receive standard EST OR EST plus EPLBD respectively. The complication rate, complete stone clearance rate and gravel incidence were compared between the two groups. 【Results】 The rate of early complications was similar in 2 groups (7/43 vs 8/44, P >0.05). The rate of successful completed stone removal was also similar in 2 groups (42/43 vs 43/44, P >0.05). However, EST group needed more procedure time (35.2±5.2) vs (45.1±4.0) min, P <0.01), so was gravel incidence (2/43 vs 8/44, P <0.05). 【Conclusion】 EST combined with EPLBD is safe and effective for extrahepatic bile duct shone removal.