EST和EPBD治疗肝外胆管结石的疗效比较  

Comparison of clinical efficacy between EST and EPBD in treatment of extrahepatic bile duct stones

作　　者：王闯 周晓华[2] 谭硕果 梁永艺 姚金科 刘建平[3] Wang Chuang;Zhou Xiaohua;Tan Shuoguo;Liang Yongyi;Yao Jinke;Liu Jianping(Department of General Surgery,Zengcheng District People's Hospital of Guangzhou,Guangzhou 511300,China;Department of Ultrasound,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Department of Biliary and Pancreatic Surgery,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]广州市增城区人民医院普通外科,511300 [2]广州医科大学附属第二医院超声科,510260 [3]中山大学孙逸仙纪念医院胆胰外科,广州510120

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期390-393,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广州市医药卫生科技项目(20151A011112)。

摘　　要：目的比较内镜下括约肌切开术(EST)和内镜下十二指肠乳头括约肌球囊扩张术(EPBD)治疗肝外胆管结石的安全性和临床疗效。方法回顾性分析2016年1月至2020年5月在广州市增城区人民医院行微创治疗的92例肝外胆管结石患者临床资料。其中男56例,女36例;平均年龄(59±5)岁。患者均签署知情同意书,符合医学伦理学规定。根据治疗方式将患者分为EST组(45例)和EPBD组(47例),观察两种治疗方式的临床疗效及术后并发症发生情况。两组并发症发生率比较采用χ^(2)检验,住院时间和费用比较采用t检验。结果EST组结石完全清除率为98%(44/45),明显高于EPBD组的85%(40/47)(χ^(2)=4.649,P<0.05)。EST组术后急性胰腺炎发生率为7%(3/45),明显低于EPBD组的21%(10/47)(χ^(2)=4.753,P<0.05);而术后出血发生率为31%(14/45),明显高于EPBD组的13%(6/47)(χ^(2)=4.548,P<0.05)。EST组术后住院时间和住院费用分别为(9.4±1.4)d、(3.59±0.28)万元,明显高于EPBD组的(6.0±0.9)d、(3.02±0.27)万元(t=5.708,4.166;P<0.05)。结论EST和EPBD均是肝外胆管结石安全有效的微创治疗方式,EST有较高的结石清除率,且术后急性胰腺炎发生率较低,而EPBD可最大程度地保护Oddi括约肌功能,具有出血发生率低、恢复快等优势。Objective To compare the clinical efficacy and safety of endoscopic sphincterotomy(EST)and endoscopic papillary balloon dilatation(EPBD)in the treatment of extrahepatic bile duct stones.Methods Clinical data of 92 patients with extrahepatic bile duct stones receiving minimally invasive treatments in Zengcheng District People's Hospital of Guangzhou from January 2016 to May 2020 were retrospectively analyzed.Among them,56 patients were male and 36 female,aged(59±5)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the EST group(n=45)and EPBD group(n=47)according to different treatments.Clinical efficacy and incidence of postoperative complications were observed in two groups.The incidence of postoperative complications was statistically compared between two groups by Chi-square test.The length of hospital stay and hospitalization expense were compared by t test.Results The complete stone removal rate in EST group was 98%(44/45),significantly higher than 85%(40/47)in EPBD group(χ^(2)=4.649,P<0.05).The incidence of postoperative acute pancreatitis in EST group was 7%(3/45),significantly lower compared with 21%(10/47)in EPBD group(χ^(2)=4.753,P<0.05).The incidence of postoperative bleeding in EST group was 31%(14/45),significantly higher than 13%(6/47)in EPBD group(χ^(2)=4.548,P<0.05).The length of postoperative hospital stay and hospitalization expense in the EST group were(9.4±1.4)d and(3.59±0.28)×104 Yuan,significantly higher than(6.0±0.9)d and(3.02±0.27)×104 Yuan in EPBD group(t=5.708,4.166;P<0.05).Conclusions Both EST and EPBD are safe and efficacious minimally invasive therapies for extrahepatic bile duct stones.EST yields higher stone removal rate and lower incidence of postoperative acute pancreatitis,whereas EPBD can protect Oddi sphincter function to the greatest extent,and has multiple advantages such as low incidence of bleeding and rapid recovery.

关 键 词：胆结石 括约肌切开术 内窥镜 球囊扩张 疗效比较研究 

分 类 号：R657.4[医药卫生—外科学]