小切口EST联合球囊扩张术治疗较大胆总管结石的临床分析  

Analysis of curative effect of small-incision EST combined with balloon dilatation in treatment of calculus of common bile duct

作　　者：程建国[1] 霞明[1] 黄继征[1] 文峰[1] 朱杰伦[1] 

机构地区：[1]解放军161医院呼吸消化内科,武汉430010

出　　处：《西南国防医药》2015年第4期394-396,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨小切口内镜下乳头括约肌切开术(EST)联合球囊扩张术(EPBD)治疗较大胆总管结石的疗效及安全性。方法最大结石直径≥1 cm的胆总管结石患者172例,随机分为联合组(n=86)和内镜下乳头括约肌切开术(EST)组(n=86),联合组在EST小切口(5 mm)基础上行EPBD治疗,EST组切口在10 mm左右。比较两组一次性结石取净率及术后并发症。结果结石一次性取净率联合组(95.3%)与对照组(96.5%)相比无显著差异(P>0.05)。术后急性胰腺炎发生率,联合组(11.6%)显著高于对照组(2.3%)(P<0.05),但胆管损伤及出血发生率,联合组显著低于对照组(P<0.05)。结论小切口EST联合EPBD治疗较大胆总管结石疗效确切,可减少胆管损伤和出血,但易并发胰腺炎,临床需要根据实际情况选择最佳方案。Objective To explore the curative effect and safety of small-incision endoscopic sphincterotomy （EST） combined with endoscopic papillary balloon dilatation （EPBD） in treatment of calculus of common bile duct. Methods 172 patients suffering from calculus of common bile duct and the maximum calculus diameter ≥ 1 cm were randomly divided into a combination group （n = 86） and an EST group （86）. EPBD was performed in the combination group on the basis of small-incision （5 mm） EST while the incisions were about 10 mm in the EST group. And then, the one-off removal rate of calculus and postoperative complication between the two groups were compared. Results The one-off removal rate of calculus in the combination group （95.3%） showed no significant difference from that in the control group （96.5%） （P 〉 0.05） ; the incidence of postoperative acute pancreatitis in the combination group （11.6%） was significantly higher than that in the control group （2.3%） （ P 〈 0.05） , but the incidence of bile duct injury and bleeding in the combination group was significantly lower than that in the control group （P 〈 0.05）. Conclusion Small-incision EST combined with EPBD in the treatment of calculus of common bile duct has definite effect; it can reduce injury and bleeding of the bile duct but is easy to be complicated by pancreatitis, so it is necessary to select the optimal scheme in clinical use according to the actual situation.

关 键 词：内镜 乳头括约肌切开术 球囊扩张术 胆总管 结石 

分 类 号：R657.42[医药卫生—外科学]