内镜下乳头括约肌切开术与球囊扩张术治疗肝外胆管结石临床疗效及安全性的比较  

Effectiveness and safety of endoscopic sphincterotomy and papillary balloon dilatation in treatment of extrahepatic bile duct stones

作　　者：董国强[1] 王庆 吴瑜 王帅 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市中西医结合医院(南开医院)微创外科,天津市300100

出　　处：《世界华人消化杂志》2015年第35期5699-5704,共6页World Chinese Journal of Digestology

基　　金：天津市中药管理局科研基金资助项目;No.13043~~

摘　　要：目的:比较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 dilatation,EPBD)治疗肝外胆管结石的有效性及安全性.方法:217例经内镜下EST或EPBD治疗肝外胆管结石的患者纳入该研究,并对其取石效果、术中X线暴露时间及近远期并发症进行比较分析.结果:EST组与EPBD组的结石完全清除率为93.8%和94.3%(P>0.05),EST组与EPBD组的术中X线暴露时间具有显著差异(P<0.05),EPBD组具有更短的X线暴露时间.EST组与E P B D组近期并发症发生率分别为16.3%和15.9%(P>0.05);内镜后胰腺炎发生率EPBD组明显高于EST组(12.5%vs 4.7%,P<0.05),所有17内镜后胰腺炎均为轻型胰腺炎;出血发生率EST组明显高于EPBD组(11.6%vs3.4%,P<0.05),所有18例出血均为可控制出血;远期复发胆管结石合并急性胆管炎的发生率EST组明显高于EPBD组(44.1%vs18.2%,P<0.05).结论:内镜下EST与EPBD是两种相对成熟、安全的治疗肝外胆管结石的方法,但EPBD能最大程度地保护Oddi括约肌的功能,降低远期并发症的发生.AIM： To compare the effectiveness and safety of endoscopic sphincterotomy （EST） and papillary balloon dilatation （EPBD） in the treatment of extrahepatic bile duct stones. METHODS： Two hundred and seventeen patients with extrahepatic bile duct stones treated by EST or EPBD were induded in this study, and the therapeutic effect, X-ray exposure time and complications were compared and analyzed. RESULTS： The complete clearance rate of stones did not differ between the EST group and EPBD group （93.8% vs 94.3%, P 〉 0.05）, and the X-ray exposure time was significantly shorter in the EPBD group than in the EST group （P 〈 0.05）. There was no significant difference in the incidence rate of complications between the two groups （P 〉 0.05）, but the incidence rate of post-endoscopic pancreatitis was significantly higher in the EPBD group than in the EST group （12.5% vs 4.7%, P 〈 0.05）. All 17 cases of post-endoscopic pancreatitis were mild. The hemorrhage rate was significantly higher in the EST group than in the EPBD group （11.6% vs 3.4%, P 〈 0.05）; all the 18 cases of hemorrhage were controllable. The rate of recurrent bile duct stones with acute cholangitis of severe type （ACST） was significantly higher in the EST group than in the EPBD group （44.1% vs 18.2%, P 〈 0.05）. CONCLUSION： Both EST and EPBD are mature and safe methods to treat extrahepatic bile duct stones, but EPBD can better protect the function of Oddi sphincter and reduce the incidence of long-term complications.

关 键 词：十二指肠乳头括约肌切开术 十二指肠乳头括约肌球囊扩张术 X线暴露时间 术后并发症 

分 类 号：R657.4[医药卫生—外科学]