内镜下十二指肠乳头小切开联合气囊扩张术治疗胆总管结石  

Clinical analysis of limited endoscopic sphincterotomy combined with endoscopic papillary balloon dilatation for the treatment of common duct stones

作　　者：张男男[1,2] 李可为[1] 张晞文[3] 丁俊[3] 姜皓[1] 李甫[3] ZHANG Nan-nan;LI Ke-wei;ZHANG Xi-wen;DING Jun;JIANG Hao;LI Fu(Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China;Department of Pancreatic and Biliary Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China;Department of General Surgery, Huashan Hospital North Baoshan Branch, Fudan University, Shanghai 200431,China)

机构地区：[1]上海交通大学医学院附属仁济医院胆胰外科,上海200127 [2]复旦大学附属华山北院宝山分院普外科,上海200431 [3]上海中医药大学附属曙光医院胰胆外科,上海200021

出　　处：《肝胆胰外科杂志》2017年第1期14-17,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的比较内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)、乳头气囊扩张术(endoscopic papilla balloon dilatation,EPBD)和乳头括约肌小切开联合气囊扩张术(limited endoscopic sphincterotomy combined with endoscopic balloon dilatation,LEST+EPBD)三种方法治疗胆总管结石的疗效。方法回顾性分析上海交通大学附属仁济医院2011年7月至2014年7月398例胆总管结石患者的临床资料,按照治疗方式分为单纯乳头括约肌切开术组(EST组,n=228例)、乳头气囊扩张术组(EPBD组,n=36例)和乳头括约肌小切开联合乳头气囊扩张术组(LEST+EPBD组,n=134例),比较分析三组的取石成功率、平均住院天数、平均住院费用、单枚结石平均最大直径、术后短期(24 h内)血淀粉酶的改变,以及近期(术后1周内)并发症如胰腺炎、出血、穿孔、胆道感染和远期(术后2年内)并发症如反流性胆管炎、结石复发等情况。结果三组性别组成、年龄、住院天数,取石成功率和一次取石成功率,差异均无统计学意义(P>0.05)。与EST组比,EPBD组和LEST+EPBD组住院费用较高,且LEST+EPBD组费用最高,差异有统计学意义(P<0.05)。与EST组及EPBD组比,LEST+EPBD组的结石直径最大,差异有统计学意义(P<0.05)。三组近期并发症比较,EPBD组胰腺炎发生率高于其他两组(P<0.05),而LEST+EPBD组与EST组比较,差异无统计学意义(P>0.05)。其他近期并发症如高淀粉酶血症、出血、穿孔、胆道感染发生率,三组比较差异无统计学意义(P>0.05)。术后远期并发症中,反流性胆管炎三组间无统计学差异(P>0.05),但LEST+EPBD组结石复发率较EST组低,差异有统计学意义(P<0.05)。结论 LEST+EPBD治疗胆总管结石是安全有效的,值得临床推广应用。Objective To study the effects of endoscopic sphincterotomy (EST), endoscopic papilla balloon dilatation (EPBD) and limited endoscopic sphincterotomy combined with endoscopic papilla balloon dilatation (LEST+EPBD) on common bile duct stones. Methods A total of 398 patients with common duct stones treated in Renji Hospital from Jul. 2011 to Jul. 2014 were divided into three groups: endoscopic sphincterotomy group (EST group, n=228), endoscopic papilla balloon dilatation group (EPBD group, n=36) and limited endoscopic sphincterotomy combined with endoscopic papilla balloon dilatation group (LEST+EPBD group, n=134). The differences of stones diameter, success rate of stone removal, hospitalization stays, total expenses, the average maximum diameter of single stones, postoperative short-term (within 24 h) analysis of blood amylase changes,the short-term (within 1 week postoperation) complications such as pancreatitis, bleeding, perforation, biliary tract infection and long-term (within 2 years) complications such as reflux cholangitis, stones recurrence, were compared among three groups. Results There were no significant difference in gender composition, age, hospitalization stays and stone removal rates among three groups (P>0.05). Compared with the EST group, there were higher hospitalization expenses in EPBD group and LEST+EPBD group, and highest in LEST+EPBD group (P<0.05). Compared with the EST group and the EPBD group, the average maximum diameter of stones in LEST+EPBD group was biggest (P<0.05). For short-term complications, EPBD group had the highest incidence of pancreatitis among three groups (P<0.05); there was no significant difference in hyperamylasemia, bleeding,perforation and biliary tract infection among three groups (P>0.05). For long-term complications, there was no significant difference in reflux cholangitis among three groups (P>0.05), but LEST+EPBD group had lower stone recurrence rate than that in EST group (P<0.05). Conclusion LEST+EPBD is safer and more effective for common bile duct stones

关 键 词：胆总管结石 乳头括约肌切开术 乳头气囊扩张术 乳头括约肌小切开联合乳头气囊扩张术 术后并发症 

分 类 号：R657.42[医药卫生—外科学]