内镜下乳头肌小切开联合球囊扩张术治疗胆总管结石的疗效及并发症分析  

Analysis of the efficacy and complications of the treatment of common bile duct stone by ESBD

作　　者：何红芳 双金权[2] 石向阳[2] 杜四清[2] 

机构地区：[1]皖南医学院研究生学院,安徽省芜湖241000 [2]池州市人民医院消化内科,安徽省池州247100

出　　处：《中国基层医药》2017年第14期2211-2214,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：基金项目：安徽省教育厅省级质量工程项目（2014sxzx033）

摘　　要：目的 探讨内镜下乳头肌小切开联合球囊扩张术（ESBD）对比乳头肌切开术（EST）治疗胆总管结石的有效性、安全性.方法 回顾性分析胆总管结石患者71例,根据手术方式分为EST组（45例）与ESBD组（26例）,观察两组一次结石清除率、术后并发症.评价其安全性和有效性.结果 两组取石成功率均在95%以上,差异无统计学意义（P〉0.05）.近期并发症：EST组出血发生率为0.0%,ESBD组3.8%,两组差异无统计学意义（P〉0.05）;两组均无穿孔病例;术后胰腺炎发生率EST组为8.8%,ESBD组为3.8%,两组差异无统计学意义（P〉0.05）.两组所取结石直径：EST组为（0.70±0.35）cm,ESBD组为（1.41±0.69）cm,两组差异有统计学意义（P〈0.05）.结论 EST与ESBD早期并发症,与取石成功率相当,但ESBD最大程度上保留了乳头括约肌的生理屏障功能,且取石直径明显大于EST组,故对于较大胆总管结石或合并乳头旁憩室者取石更为安全.Objective To compare the effect and safety of endoscopic duodenal papillal incision combined dilatation（ESBD） and endoscopic sphincterotomy（EST） in the treatment of common bile duct stone.Methods A retrospective analysis of 71 cases of choledocholithiasis,according to surgical methods,were divided into group EST （45 cases） and group ESBD （26 cases）.The effect and safety of the above two kinds of treatment was evaluated through observing the rate of one-time stone clearance and postoperative complications.Results The success rate of removing calculous of the two groups was above 95%,and there was no significant difference between the two kinds of treatment（EST and ESBD）（P〉0.05）.Recent complications：the incidence rate of hemorrhage of the EST group was 0.0%,which of the ESBD group was 3.8%,there was no significant difference between the two groups（P〉0.05）.The incidence rate of postoperative pancreatitis of the EST group was 8.8%,which the ESBD group was 3.8%,there was no significant difference between the two groups（P〉0.05）.The diameter of the removed stone of the two groups：the EST group was （0.70±0.35）cm,and the ESBD group was （1.41±0.69）cm,there was significant difference between the two groups（P〈0.05）.Conclusion There are no significant differences in early complications and the success rate of removing stone between the EST group and the ESBD group.However,ESBD preserved teat sphincter＇s physiological barrier function to the greatest extent and the diameter of the removed stone was obviously larger than the EST group.Therefore,it is much safer for those who have quite large common bile duct stone or people who are with joint periampullary diverticulum to be treated by ESBD.

关 键 词：胆总管结石 括约肌切开术 内窥镜 气囊扩张术 

分 类 号：R657.42[医药卫生—外科学]