合并壶腹周围憩室胆总管结石的三种不同内镜治疗方法的对比研究  

A comparative study on three endoscopic methods for removal of common bile duct stones accompanied with periampullary diverticula

作　　者：汪洋[1] 叶丽萍[2] 林敏华[2] 毛鑫礼[2] 周贤斌[2] 何必立[2] 盛显仓 张金顺[2] 张玉[2] 骆定海[2] 

机构地区：[1]浙江省台州市第一人民医院消化内科,318020 [2]浙江省台州医院消化内科

出　　处：《中华消化内镜杂志》2015年第5期290-295,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的通过比较3种内镜方法治疗合并壶腹周围憩室（periampullary diverticula，PAD）胆总管结石的疗效及安全性，探讨治疗合并PAD胆总管结石的安全有效的方法。方法将2012年12月至2013年7月期间收治的154例合并PAD胆总管结石患者根据随机数字表法分为乳头括约肌切开组（EST组）、乳头柱状气囊扩张术组（EPBD组）、乳头小切开联合柱状气囊扩张术组（ESBD组）三组，分别予EST、EPBD、ESBD取石治疗，并随访12个月，比较完全结石清除率、一次结石清除率、机械碎石器使用率、需紧急碎石率、平均取石次数、平均取石时间及并发症的发生率。结果ESBD组的一次结石清除率高于EST组和EPBD组（94．12％比78．43％，73．08％，P〈0．05）；ESBD组的平均取石次数少于EPBD组（1．08比1．31，P〈0．05）；ESBD组近期并发症发生率低于EPBD组（15．69％比34．61％，P〈0．05），ERCP术后高淀粉酶血症发生率低于EPBD组（5．88％比21．15％），差异有统计学意义（P〈0．05）。EST组的胆道积气发生率高于EPBD组（52．27％比26．19％，P=0．013）及ESBD组（52．27％比27．66％，P=0．016）。结论ESBD的取石疗效明显优于EST及EPBD，其安全性与传统的EST相似，比EPBD更加安全。ESBD是一种治疗合并壶腹周围憩室的胆总管结石的安全有效的方法。Objective To evaluate the safety and effectiveness of three endoscopic methods for removal of common bile duct stones （CBDs） accompanied with periampullary diverticula（PAD）. Methods A total of 154 patients hospitalized at Taizhou Hospital and Taizhou No. 1 People＇s Hospital of Zhejiang province from December 2012 to July 2013 were divided randomly into three groups, i. e. , EST, EPBD and ESBD group, and received the treatment of EST, EPBD and limited EST plus EPBD （ESBD） to extract CBDs, respectively. After 12 months of follow-up, the rate of full stone clearance, stones clearance rate in one time, the rate of mechanical lithotripsy, the rate of urgent lithotripsy, the average procedures, the average removal time and the complication incidence among three groups were compared. Results The rates of stone clearance in one time in group ESBD was higher than those of group EST and group EPBD （94. 12% VS 78.43%, 73.08% ; P 〈 0. 05 ） with significant difference. The average proeedures in group ESBD was lower than that of group EPBD （1.08 VS 1.31 ,P 〈0. 05） ,which also showed significant difference. The occurrence rates of early complication in group ESBD was lower than that of group EPBD （ 15.69% VS 34. 61%, P 〈 0. 05 ）. The occurrence rates of post-ERCP hyperamylasemia in group ESBD was lower than that of group EPBD （5.88% VS 21.15% ） with significant difference （P 〈0. 05）. The incidence of pneumobilia in group EST was higher than those of group EPBD （52. 27% VS 26. 19% ,P =0. 013） and group ESBD （52. 27% VS 27.66% ,P =0. 016）. Conclusion The stone extraction efficiency of ESBD is better than that of EST and EPBD. Compared with conventional EST, ESBD shows similar safety level, and is safer than EPBD. So ESBD is a safe and effective method to remove CBDs with PAD.

关 键 词：胰胆管造影术 内窥镜逆行 壶腹周围憩室 胆总管结石 气囊扩张术 

分 类 号：R657.4[医药卫生—外科学]