内镜下十二指肠乳头括约肌切开术与十二指肠乳头球囊扩张术在治疗胆总管结石中的比较  

Endoscopic sphincterotomy vs endoscopic papillary balloon dilation for retrieval of common bile duct stones

作　　者：席利力[1] 高鸿亮[1] 排组拉.沙拉依阿当 姚萍[1] 

机构地区：[1]新疆医科大学第一附属医院消化内科,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《世界华人消化杂志》2015年第32期5222-5227,共6页World Chinese Journal of Digestology

摘　　要：目的:对比研究内镜下十二指肠乳头扩约肌切开术(endoscopic sphincterotomy,EST)与十二指肠乳头括约肌球囊扩张术(endoscopic papillary balloon dilation,EPBD)治疗胆管结石的安全性和有效性.方法:回顾性分析新疆医科大学第一附属医院266例胆管结石住院患者的临床资料,分别对EST组和EPBD组病例的基本情况、结石直径、取石方法、结石取净率、并发症等进行比较.结果:EST组和EPBD组结石清除率分别为94.1%和95.4%(P>0.05);EST组和EPBD组总体并发症的发生率分别为9.6%和11.5%(P>0.05);EPBD组术后胰腺炎的发生率高于EST组,分别为9.2%和3.7%(P<0.05);术后出血仅发生在EST组(P<0.05);胰管造影和机械碎石是EST或EPBD术后急性胰腺炎的风险因素;毕二式胃大部切除术后,十二指肠乳头旁憩室,胆管结石直径均是影响结石成功取出的因素.结论:EST和EPBD在取石成功率方面效果相似;总体并发症的发生率相近;胰管造影和机械碎石是术后急性胰腺炎的风险因素;EPBD操作简便,特别适合凝血功能障碍和需要抗凝治疗的患者,EPBD在胆管结石的治疗中有广泛前景.AIM：To compare the efficacy and safety of endoscopic papillary balloon dilation（EPBD）with endoscopic sphincterotomy（EST） in the treatment of common bile duct stones.METHODS：A retrospective review of 266 patients with common bile duct stones treated at our hospital was conducted.Basic situations,stone diameter,stone extraction method,stonefree rate,and complications were compared between the EST group and EPBD group.RESULTS：Complete stone clearance was achieved in 94.1%of patients in the EST group and 95.4%of those in the EPBD group（P〉0.05）.Complications occurred in 9.6%of patients in the EST group and 11.5%of those in EPBD group（P〉0.05）.The frequency of acute pancreatitis was higher in the EPBD group than in the EST group（9.2%us 3.7%;P〈0.05）.Hemorrhage occurred only in the EST group（P〈0.05）.Performances of pancreatography and mechanical lithotripsy were risk factors for postoperative pancreatitis.Billroth Ⅱ gastrectomy,peripapillary duodenal diverticulum,and bile duct stone diameter were factors influencing successful stone removal.CONCLUSION：EST and EPBD are approximately equivalent in terms of successful clearance of common bile duct stones and overall complications.Performances of pancreatography and mechanical lithotripsy are risk factors for postoperative pancreatitis.The procedure of EPBD is more simple and especially safer for elderly and patients with coagulation dysfunction or requiring anti-coagulation treatment.

关 键 词：十二指肠乳头括约肌切开术 十二指肠乳头球囊扩张术 胆总管结石 

分 类 号：R575.7[医药卫生—消化系统] R656.7[医药卫生—内科学]