内镜下小切开联合大球囊扩张术治疗胆总管大结石效果及安全性分析  

Effect and safety analysis of minor endoscopic sphincterotomy plus large balloon dilatation in the treatment of choledocholithiasis

作　　者：张科[1] 陆志平[1] 成翠娥[1] 黄国进[1] ZHANG Ke;LU Zhi-ping;CHENG Cuie;HUANG Guo-jin(Department of Gastroenterology, Changshu Second People’sHospital, Jiangsu, Changshu, 215500 China)

机构地区：[1]常熟市第二人民医院消化内科

出　　处：《现代消化及介入诊疗》2019年第5期478-481,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的 评估小切开联合大球囊扩张术(mEST+EPLBD)治疗胆总管大结石临床疗效及近远期并发症。方法 选取2015年1月至2017年12月的胆总管大结石(≥1.0cm)患者116例,随机分为EST组(61例)和mEST+EPLBD组(55例)。EST组患者采用常规EST治疗,mEST+EPLBD组患者采用mEST+EPLBD治疗,观察两组取石成功率、取石时间、机械碎石率、住院时间及近远期并发症发生情况。结果 mEST+EPLBD组和EST组一次性取石成功率分别为94.5%和80.3%(P<0.05),取石时间为(21.6±6.7)min和(17.8±4.5)min(P<0.05),机械碎石率为7.3%和21.3%(P<0.05)。两组近期并发症和住院时间比较,差异无统计学意义(P>0.05);mEST+EPLBD组远期并发症发生率为3.6%,显著低于EST组的19.7%(P<0.05)。结石直径≥14mm、结石数目≥2个、机械碎石和EST是ERCP术后结石复发的危险因素。结论 mEST联合EPLBD能够有效、安全地清除胆总管大结石,降低远期并发症发生率。Objective To evaluate the clinical efficacy and short-term and long-term complications of minor endoscopic sphincterotomy plus large balloon dilatation (mEST + EPLBD) in the treatment of large common bile duct stones. Methods A total of 116 patients with large common bile duct stones (>1.0 cm) from January 2015 to December 2017 were selected, 61 patients received routine EST and 55 patients received mEST + EPLBD. The success rate, time of stone removal, mechanical lithotripsy rate, hospitalization time and short-term and long-term complications were observed. Results The rate of stone clearance with the first session in mEST+EPLBD and EST groups was 94.5%(52/55) and 80.3%(49/61)( P <0.05),the stone removal time was (21.6±6.7)min and (17.8±4.5)min( P <0.05),the usage rate of mechanical lithotripsy was 7.3%(4/55) and 21.3%(13/61)( P <0.05). The was no significant differences in the short-time complications and hospitalization time. The long-time complications occurred in 2 case in mEST+EPLBD group (1 case of stone recurrence , and 1 case of cholangitis), and 12 cases in EST group (9 case of stone recurrence, and 3 case of cholangitis). Stone diameter (≥ 14 mm), stone number (≥2), mechanical lithotripsy and EST were risk factors for stone recurrence. Conclusion mEST+EPLBD can remove large common bile duct stones more effectively and safely, with a low incidence of long-term complications.

关 键 词：胆总管结石 内镜 括约肌切开 球囊扩张 

分 类 号：R575.7[医药卫生—消化系统]