内镜下球囊扩张术和括约肌小切开术治疗非扩张性肝外胆管结石的临床分析  

Clinical effect of endoscopic papillary balloon dilation combined withendoscopic sphincterotomy for treatment of non⁃dilated extrahepatic bile duct stones

作　　者：高黎黎 张霞芬 张昊 Gao Lili;ZHANG Xiafen;ZHANG Hao(Center for Medical Research and Innovation,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China;不详)

机构地区：[1]上海市浦东医院(复旦大学附属浦东医院)医学科研与创新中心,上海201399 [2]上海市浦东医院(复旦大学附属浦东医院)普外科,上海201399

出　　处：《实用医学杂志》2021年第14期1846-1851,共6页The Journal of Practical Medicine

基　　金：上海市浦东新区卫生和计划生育委员会科技发展专项基金资助青年科技项目(编号:PW2016B⁃15);复旦大学附属浦东医院院级课题项目资助(编号:2015YJ⁃09)。

摘　　要：目的评估内镜下球囊扩张术(EPBD)和括约肌切开术(EST)治疗非扩张性肝外胆管结石的疗效和安全性。方法回顾性收集非扩张性和扩张性肝外胆管结石患者行内镜逆行胰胆管造影(ERCP)的临床资料,比较扩张组和非扩张组患者的疗效及并发症的差异;根据术式将非扩张组患者分为:EPBD组、小切开组和联合治疗组(小切开术+EPBD),比较不同术式下患者的疗效和并发症的差异。结果与扩张组患者相比,非扩张组患者术后1周内急性胰腺炎(PEP)和高淀粉酶血症(HP)的发生率较高(P<0.05),但均为轻、中度PEP,未出现重度患者;应用EPBD、小切开术和联合方式治疗非扩张性肝外胆管结石均能达到取净结石的目的(P>0.05),并发症中仅PEP和HP的发生差异有统计学意义(P<0.05);两两比较结果显示,小切开组和联合治疗组PEP和HP发生率较EPBD组低(P<0.05)。结论小切开术及联合治疗的效果较好且PEP和HP发生率低;结合减少操作及成本效益原则,小切开术对非扩张性肝外胆管结石有较高的临床应用价值。Objective To evaluate the efficacy and safety of endoscopic papillary balloon dilation(EPBD)combined with endoscopic sphincterotomy(EST)for the treatment ofnon⁃dilated extrahepatic bile duct stones(Non⁃DEBDS).Methods The clinical data of patients with dilated extrahepatic bile duct stones(DEBDS)and NDEBDS treated with endoscopic retrograde cholangiopancreatography(ERCP)were collected and analyzedto compare the efficacy and safety of ERCP between the two groups.According to the therapies they received,the patients with non⁃dilated extrahepatic bile duct stones were divided into EPBD group(n=75),minor EST group(n=75),and minor EST combined with EPBD(EST⁃EPBD)group(n=87),and the efficacy and safety of the three groups were evaluated.Results The DEBDS group was less likely to develop with hyperamylasemia(HP)and post⁃ERCP pancreatitis(PEP)than the Non⁃DEBDS group within one week after surgery(P<0.05),some cases developed with mild or moderate pancreatitis,but none with severe conditions.All the treatment methods were effective for clearing the stones completely in the non⁃DEBDS patients(P>0.05).The pairwise comparison results showed that the incidences of HP and PEP in the EPBD group were both higher than in other groups,respectively(P<0.05).Conclusion The endoscopic papillary balloon dilation combined with endoscopic sphincterotomy achieves a better effect in treatment of non⁃dilated extrahepatic bile duct stones,with lower incidences of PEP and HP.It is of higher value clinically in terms of reduced operation and surgical costs.

关 键 词：非扩张性肝外胆管结石 十二指肠镜下乳头括约肌切开术 十二指肠镜下乳头气囊扩张术 内镜逆行胰胆管造影 术后胰腺炎 

分 类 号：R657.4[医药卫生—外科学]