胆总管结石乳头括约肌小切开联合气囊扩张术代替乳头括约肌切开术的可行性研究  

A study on the combined use of small endoscopic sphincterotomy plus balloon dilation to replace endoscop- ic sphincterotomy in the removal of common duct stones

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：《中华肝胆外科杂志》2013年第6期411-415,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评价胆总管结石乳头括约肌小切开联合气囊扩张术代替乳头括约肌切开术的可行性。方法将2008年5月至2011年4月收治的符合纳入标准的462例胆总管结石患者随机分为两组：乳头括约肌小切开联合大气囊扩张组与乳头括约肌切开组。比较两组一次性结石取净率、总的结石取净率、机械碎石使用率、操作时间、射线照射时间及短期并发症的发生率。结果乳头括约肌小切开联合大气囊扩张更高效。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（12．1％比34．8％，P〈0．05）取得了更高的一次性结石取净率（86．2％比70．4％，P〈0．05），并且操作时间[（38．6±15．5）min比（47．1±20．2）min，P〈0．05]与射线曝光时间[（17．3±7．O）min比（26．5±10．8）min，P〈0．05]显著缩短。两组患者总的结石取净率（96．5％比93．5％，P〉0．05）、24h并发症发生率（6．9％和11．7％，P〉0．05）差异无统计学意义。结论对于胆总管结石，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安全。但乳头括约肌小切开联合大气囊扩张术更加高效，未来有望取代乳头括约肌切开术成为胆总管结石的首选。Objective To evaluate whether small endoscopic sphincterotomy （EST） plus balloon dilation （EPBD） can replace endoscopic sphincterotomy （EST） alone for patients with common bile duct （CBD） stones. Methods From May 2008 to April 20]1, 462 patients with CBD stones were randomly divided into two groups. The success rate of complete stone removal after the first session, the rate of using mechanical lithotripsy （ML）, the short-term complications, the procedure time and fluoroscopy time were compared between the two groups. Results Overall ductaI clearance did not differ between the two groups （96.5% vs 93.5%, P〉0.05）. The complication rates at 24 hours were 6.9% for the small EST plus EPBD group and 11.7% for the EST group （P〉0.05）. However, the rate of complete stone removal after the first session using small EST plus EPBD was significantly higher than EST alone （86.2% vs 70.4%, P〈0. 05）. ML was required significantly more often in the EST group when compared with the small EST plus EPBD group （34.8% vs 12.1%, P〈0.05）.The total procedure time and total fluoroscopy time in the small EST plus EPBD group were significantly shorter than the EST group [（38.6±15.5） min vs （47.1±20.2） min, P〈0.05 and （17.3±7.0） min vs （26.5±10.8） min, P〈0.05]. Conclusions Compared with EST, small EST plus EPBD was safe and more efficacious for bile duct stones. In the future, small EST plus EPBD probably can replace EST to be the first treatment of choice for bile duct stones.

关 键 词：胆结石 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]