乳头括约肌小切开联合大气囊扩张术在胆总管结石内镜治疗中的作用研究  

Endoscopic sphincterotomy combined with large balloon dilation for bile duct stones

作　　者：夏挺松[1] 刘鹏飞[1] 张伟[1] 沈卫东[1] 徐娟[1] 孙芳[1] 仲芳[1] 

机构地区：[1]东南大学医学院附属江阴医院消化科,江苏省江阴市214400

出　　处：《中华消化内镜杂志》2012年第8期455-457,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨乳头括约肌小切开联合大气囊扩张术在胆总管结石内镜治疗中的安全性和有效性。方法83例胆总管结石行ERCP治疗患者采用随机数字表法随机分成2组，观察组42例接受乳头括约肌小切开联合大气囊扩张，对照组41例接受传统乳头括约肌切开，比较2组问结石取净率、取石次数、机械碎石率、操作时间及早期并发症发生情况。结果观察组无一例穿孔，发生出血2例（4．8％）、胰腺炎5例（11．9％），总体并发症发生率为16．7％（7／42）；对照组发生穿孔1例（2．4％）、出血5例（12．2％）、胰腺炎3例（7．3％），总体并发症发生率为22．0％（9／41）；2组总的并发症发生率及每种并发症发生率比较差异均无统计学意义（P〉0．05）。2组共有3例取石失败，其中观察组1例，对照组2例，其余患者均经1～2次ERCP取净结石，观察组结石取净率、机械碎石率、2次取石率、操作时问分别为97．6％（41／42）、4．8％（2／42）、2．4％（1／42）和（29．2±5．3）min，对照组分别为95．1％（39／41）、22．0％（9／41）、19．5％（8／41）和（38．8±4．3）min，2组结石取净率比较差异无统计学意义（P〉0．05），其他3项比较差异均有统计学意义（P〈0．05）。结论乳头括约肌小切开联合大气囊扩张术与传统乳头括约肌切开同样安全有效，但操作更为简便。Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy （EST） combined with large balloon dilation for bile duct stones. Methods A total of 83 patients with com- mon bile duct stones were randomly divided into 2 groups to receive standard EST （n = 41, EST group） or EST plus large balloon dilation （ n = 42, EPLBD group） , respectively. The number of endoscopic session, operation time, rates of successful complete stone retrieval, mechanical lithotripsy, and procedure related complication were compared between the two groups. Results The rate of early procedure-related complica- tions was similar in 2 groups （9/41 vs. 7/42, P 〉 0. 05 ）, including perforation （ 1/41 vs. 0/42, P 〉 0. 05 ）, bleeding （5/41 vs. 2/42, P 〉0. 05） and pancreatitis （3/41 vs. 5/42, P 〉0. 05）. The rate of suc- cessful complete stone removal was also similar in 2 groups （39/41 vs. 41/42, P 〉 0. 05）. However, EST group needed more procedure time （38. 8 ± 4. 3 min vs. 29.2 ± 5.3 rain, P 〈 0. 01 ） and use of mechanical lithotripsy to achieve complete stone removal （9/41 vs. 2/42, P 〈 0. 05 ）. Only one patient in EPLBD group （ 1/42, 2.4% ） needed a second ERCP to clear bile duct stone, while in EST group, 8 patients underwent a second procedure （ 19. 5% , P 〈 0. 05）. Conclusion For endoscopic removal of common bile duct stones, EST combined with large balloon dilation is as safe and effective as EST, while easier in manipulation.

关 键 词：胆总管结石 括约肌切开术 内窥镜 气囊扩张术 

分 类 号：R657.4[医药卫生—外科学]