乳头括约肌小切开加大口径柱状气囊扩张治疗胆总管结石的价值  

The values of minor endoscopic sphincterotomy plus large-diameter balloon dilatation for removal of common bile duct stones

作　　者：苏进根[1,2] 王建平[1,2] 陆奕宁[1,2] 陈秋[1,2] 施凤娟[1,2] 

机构地区：[1]上海交通大学附属仁济医院嘉定分院 [2]嘉定区中心医院普外科,上海201800

出　　处：《肝胆外科杂志》2015年第2期130-133,共4页Journal of Hepatobiliary Surgery

基　　金：上海市嘉定区科学技术发展基金资助(编号201231)

摘　　要：目的探讨采用内镜下乳头括约肌小切开加大口径气囊扩张(ESBD)治疗胆总管结石的有效性及并发症。方法将90例肝外胆管结石且胆管直径>13 mm的患者,随机分成3组各30例,EST(内镜下乳头括约肌切开)组、EPBD(内镜下乳头柱状气囊扩张术)组、ESBD组,再行取石治疗。观察3组病例的结石清除率、结石清除时间、多次取石数、碎石器使用率及并发症等情况。结果 EST、EPBD和ESBD组I期结石清除率分别为96.7%(29/30)、90.0%(27/30)和100%(30/30)(P=0.160),结石清除时间分别为(21.50±6.69)min、(22.97±6.62)min和(17.77±4.37)min(P=0.004),碎石器使用率分别为36.7%、30.0%和10.0%(P=0.048),多次取石数分别为23、25和16例(P=0.027)。3组近期并发症差异无统计学意义;远期并发症分别为8、4和1例(P=0.036)。结论内镜下乳头括约肌小切开加大口径气囊扩张是清除胆总管结石的有效方法,尤其适合于胆总管巨大结石或行乳头切开取石困难者。Objective To investigate the efficiency and complications of endoscopic minor sphincterotomy plus large balloon dilatation （ESBD） for treatment of common bile duct （CBD） stones. Methods 90 Patients with extra-hepatic bile duct stones and with the diameter of CBD larger than 13 mm were randomly divided into 3 groups with 30 patients in each group that were received en- doscopic maximal sphincterotomy （EST） group, endoscopic papillary balloon dilation （EPBD） group and ESBD group respectively, followed by conventional stones removal and/or lithotripsy. The successful rate and time of stone clearance, repeatedly stone removal, the rate of mechanical lithotripsy and related complications were observed. Results The rate of stones clearance with single session in 3 groups were 96. 7% （29/30）, 90. 0% （27/30） 和 100% （30/30） （EST vs EPBD vs ESBD, P = 0. 160） respectively. The stone-re- moval time were （21.50 ± 6.69 ） min, （22. 97 ± 6. 62） min and （ 17.77 ± 4. 37 ） rain （ P = 0. 004 ）. The rate of mechanical lithotripsy were 36.7%, 30. 0% and 10. 0% （P =0. 048）. Repeatedly stone removal were 23, 25 and 16 cases respectively （P =0. 027）. The short-term complications occurred in 4 eases in EST （3 mild pancreatitis, 1 hemorrhage）, 3 eases in EPBD （3 milt pancreatitis）, and 1 case in ESBD （1 mild pancreatitis） （P = 0. 383 ）. No death happened in any group. The long-term complications occurred in 8 cases in EST （3 recurrent choledocholithiasis, 4 cholangitis, 1 bile reflux） ,4 eases in EPBD （2 recurrent choledoeholithiasis, 2 eholangi- tis）, and 1 case in ESBD （ 1 recurrent choledocholithiasis） （ P = O. 036 ）. Conclusion ESBD is an effective and safe method for clear- ance of CBD stones, especially for large stones or diffieuh sphincterotomy.

关 键 词：胆总管结石 内窥镜 括约肌切开术 气囊扩张术 

分 类 号：R657.4[医药卫生—外科学]