乳头括约肌小切开联合大气囊扩张术治疗胆总管结石（≥12mm）的疗效及安全性评价  

Small endoscopic sphincterotomy plus large balloon dilatation for common bile duct stones larger than 12mm： a randomized comparative study with endoscopic sphincterotomy

作　　者：李国栋[1] 庞秋萍[1] 张秀娟[1] 董海燕[1] 郭荣[1] 翟海兰[1] 贾欣永[1] 

机构地区：[1]山东省千佛山医院内镜诊疗科,济南250014

出　　处：《中华消化内镜杂志》2013年第4期189-193,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价经内镜乳头括约肌小切开联合大气囊扩张方法与单纯乳头括约肌切开术进行胆总管结石（≥12mm）取石的疗效及安全性。方法198例胆总管结石（≥12mm）患者随机数字法随机分为两组：乳头括约肌小切开联合大气囊扩张组（100例）与乳头括约肌切开组（98例）。比较两组一次性结石取净率、结石取净率、机械碎石使用率、操作时间、X线照射时间及术后并发症的发生率。结果与乳头括约肌切开组相比，乳头括约肌小切开联合大气囊扩张组以更低的机械碎石使用率（12．0％比35．7％，P〈0．05）取得了更高的一次性结石取净率（89．0％比71．4％，P〈0．05），并且操作时间[（39．3±15．8）min比（48．4±19．3）min，P〈0．05]与X线照射时间[（14．2±5．2）min比（24．2．±9．4）min，P〈0．05]显著缩短；而总的结石取净率（97．0％比93．9％，P〉0．05）、并发症的发生率（8．0％比13．3％，P〉0．05）无统计学差异。结论对于胆总管结石（≥12mm），乳头括约肌小切开联合大气囊扩张与乳头括约肌切开同样有效、安全，前者更加高效。Objective To evaluate the efficacy and safety of small endoscopic sphincterotomy （EST） plus large balloon dilataion （EPLBD） for removal of common bile duct （CBD） stones larger than 12mm. Methods From June 2009 to December 2011, a total of 198 patients with CBD stones were randomly divided into two groups to receive EPLBD （ n = 100） or EST only （ n = 98 ）. The rate of complete stone removal after the first session, the overall success rate of stone removal, the rate of using mechanical lithotripsy （ ML）, the rate of post procedure complication, procedure time and fluoroscopy time were compared between the two groups. Results The rate of complete stone removal after the first session in EPLBD group （89.0%） was significantly higher than that in EST group （71.4%, P 〈0. 05）. ML was required significantly more often in EST group （35.7%） compared to EPLBD group （ 12. 0%, P 〈0. 05）. Total procedure time and total fluoroscopy time in EPLBD group （39.3 ± 15.8 min and 14. 2 ±5.2 min） were significantly shorter than those of EST group （48.4 ± 19.3 min and 24. 2 ± 9.4 min, P 〈 0. 05 ）. There was no significant difference between two groups in overall success rate of stone removal （97.0% in EPLBD vs. 93.9% in EST group, P 〉0.05） and the complications rate （8.0% in EPLBD vs. 13.3% in ESTgroup, P 〉 0. 05）. Conclusion EPLBD is as safe and effective as EST for common bile duct stones, larger than 12mm, and is more efficient in terms of procedure time, use of ML and success rate of stone removal.

关 键 词：胆总管结石 括约肌切开术 内窥镜 内镜下乳头气囊扩张术 

分 类 号：R657[医药卫生—外科学]