内镜下乳头肌小切开联合气囊扩张治疗胆总管结石的疗效及安全性分析  

Efficacy and Safety Analysis of Endoscopic Papillary Myotomy combined with Balloon Dilation in the treatment of Choledocholithiasis

作　　者：王彬彬 WANG Binbin(Chizhou People's Hospital, Anhui Chizhou 247000, China)

机构地区：[1]安徽省池州市人民医院消化内科

出　　处：《河北医学》2019年第12期2057-2061,共5页Hebei Medicine

基　　金：安徽省自然科学基金项目,(编号:1707056MH186)

摘　　要：目的:探究内镜下乳头肌小切开(SEST)联合气囊扩张(EPBD)治疗胆总结石的临床疗效及安全性。方法:取2015年6月至2018年7月在本院接受SEST联合EPBD治疗胆总管结石患者34例为SEST联合EPBD组;单纯内镜下乳头肌切开(EST)治疗患者46例为EST组。比较两组患者的一次结石取净率、取石大小及术后并发胰腺炎、高淀粉酶血症、胆管炎情况;评估SEST联合EPBD对胆总结石的治疗效果。结果:治疗结果显示EST组一次结石取净率(97.83%)高于SEST联合EPBD组(97.06%),差异无统计学意义(P>0.05);取石直径显著小于SEST联合EPBD组,差异具有统计学意义(P<0.05)。不同时点血淀粉酶水平比较结果显示,血淀粉酶EST组各时点均高于SEST联合EPBD,且术后3h升高最为明显,24h后呈下降趋势,差异具有统计学意义(P<0.05)。另外两组术后均胃肠道出血、PEP、高淀粉酶血症、胆管炎情况发生,且EST组的并发症总发生率高于SEST联合EPBD组(41.3%、17.65%,χ^2=5.093,P<0.05)。结论:SEST联合EPBD治疗胆总管结石与单纯EST治疗相比一次性取石成功率基本相当,但SEST联合EPBD取石直径明显大于单纯EST,且术后并发症少。故SEST联合EPBD对于治疗胆总管结石者其疗效更佳且安全性较高。Objective: To explore the endoscopic papillary muscle of small incision(SEST) with balloon dilation(EPBD) therapy bravery to summarize the clinical efficacy and safety of the stone. Methods: From June 2015 to July 2018, 34 patients with choledocholithiasis treated in our hospital by SEST combined with EPBD were selected as SEST combined with EPBD group 46 patients treated by EST wereselected as EST group. The stone removal rate, stone size, pancreatitis, hyperamylasemia and cholangitis were compared between the two groups. The effect of SEST combined with EPBD was evaluated in the treatment of choledocholithiasis. The stone removal rate, stone size, pancreatitis, hyperamylasemia and cholangitis were compared between the two groups. Results: The results showed that the stone removal rate of EST group(97.83%) was higher than that of EST combined with EPBD group(97.06%)(P> 0.05). The stone diameter was significantly smaller than that of the SEST combined with EPBD group(P<0.05). The results showed that the level of serum amylase in EST group was higher than that in EST combined with EPBD at different time points, and it was the most obvious increase at 3 hours after operation, and it was decreased after 24 hours, the difference was statistically significant(P<0.05). In addition, gastrointestinal bleeding, PEP, hyperamylasemia and cholangitis occurred in both groups, and the total incidence of complications in EST group was higher than that in SEST combined with EPBD group(41.3%, 17.65%, χ 2 = 5.093, P<0.05). Conclusion: Compared with the simple EST treatment, the success rate of single stone removal is almost the same, but the stone removal diameter of SEST combined with EPBD is significantly larger than that of simple EST, and the postoperative complications are less. Therefore, SEST combined with EPBD is more effective and safe in the treatment of choledocholithiasis.

关 键 词：胆总管结石 乳头肌小切开 气囊扩张 并发症 

分 类 号：R657.4[医药卫生—外科学]