经内镜乳头括约肌切开术与球囊扩张术治疗梗阻性黄疸的临床评价  

Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice

作　　者：韩岩智[1] 朱晓丹[1] 尚国臣[1] 郑勇[1] 陈卫刚[1] 

机构地区：[1]石河子大学医学院第一附属医院消化内科,新疆维吾尔自治区石河子市832000

出　　处：《世界华人消化杂志》2015年第6期984-989,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)与内镜下球囊扩张术(endoscopic papillary balloon dilation,EPBD)及两者联合对治疗梗阻性黄疸的疗效.方法:回顾性分析石河子大学医学院第一附属医院消化内科2013-01/-2014-08 97例行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术的梗阻性黄疸患者的临床资料.结果:E S T组55例、EPBD组8例以及内镜下乳头小切开联合球囊扩张术(small endoscopic sphincterotomy associated with balloon dilatation,sEST+EPBD)组34例.术后患者腹痛、黄疸等症状明显缓解.sEST+EPBD组一次取石成功率明显高于单纯EST及单纯EPBD组,具有统计学意义(P<0.05);合并十二指肠憩室的胆管结石,s EST+EPBD组较EST组有更高的取石成功率(P<0.05);高淀粉酶血症的发生率组间差异有统计学意义(P<0.05),其中EPBD组高淀粉酶血症发生率明显高于EST组(P<0.05).结论:s EST+EPBD、EST、EPBD三种术式均为治疗梗阻性黄疸有效减黄措施,而s EST+EPBD术较单纯EST术及EPBD术有较高的取石成功率,尤其适用于十二指肠憩室等胆道解剖结构改变的患者.其术后并发症少,弥补了单纯EPBD术不足,且安全有效,值得临床推广.AIM： To assess the clinical effects of endoscopic sphincterotomy （EST） and endoscopic papillary balloon dilation （EPBD）, alone or in combination, in the management of obstructive jaundice.METHODS： A retrospective analysis was performed of the clinical data of 97 patients with obstructive jaundice treated at the First Affiliated Hospital of Shihezi University from January 2013 to August 2014. RESULTS： The 97 patients were divided into three groups： an EST group （n = 55）, an EPBD group （n = 8） and a small EST plus balloon dilatation （sEST ＋ EPBD） group （n = 34）. The clinical symptoms such as abdominal pain and jaundice were relieved obviously after these treatments. The success rate of first stone removal was significantly higher in the sEST ＋ EPBD group than in the other two groups （P 〈 0.05）. For choledocholithiasis with duodenal diverticula, the sEST ＋ EPBD group also had a significantly higher success rate of stone removal than the EST group （P 〈 0.05）. The EST group had a significantly lower rate of hyperamylasemia compared with the EPBD group （P 〈 0.05）. CONCLUSION： EST, EPBD, and sEST ＋ EPBD are all effective for palliative treatment of biliary obstruction, sEST ＋ EPBD is associated with a higher rate of stone removal and a lower incidence rate of postoperative complications, especially for patients with biliary anatomical changes such as duodenal diverticulum.

关 键 词：内镜下十二指肠乳头括约肌切开术 内镜下球囊扩张术 内镜下乳头小切开联合球囊扩张术 梗阻性黄疸 

分 类 号：R657.4[医药卫生—外科学]