十二指肠镜下乳头括约肌切开术及气囊扩张术治疗非扩张性肝外胆管结石的疗效分析  

Clinical analysis of EST and EPBD in the treatment of non-dilated extrahepatic bile duct stones

作　　者：郭晋芳 张健康[2] 李悦[2] GUO Jin-fang;ZHANG Jian-kang;LI Yue(Shanxi Medical University,Taiyuan 030001;Department of Gastroenterology,the First Affiliated Hospital of Shanxi Medical University,China,Taiyuan 030001)

机构地区：[1]山西医科大学第一临床医学院,030001 [2]山西医科大学第一附属医院消化内科,030001

出　　处：《现代消化及介入诊疗》2022年第8期956-960,965,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：山西省基础研究计划项目(晋财教[2021]131-1号20210302123243)。

摘　　要：目的比较十二指肠镜下乳头括约肌切开术(EST)、十二指肠镜下乳头气囊扩张术(EPBD)以及EST+EPBD治疗非扩张性肝外胆管结石的临床疗效和安全性。方法回顾性分析2020年9月至2022年1月因非扩张性肝外胆管结石在山西医科大学第一医院行内镜下治疗的患者118例,根据手术方式将患者分为EST组(n=45)、EPBD组(n=35)和EST+EPBD组(n=38),比较三组患者术后近、远期并发症的发生率、围术期指标、治疗前与治疗后7 d的相关血清学指标。结果EPBD组高淀粉酶血症、胰腺炎发生率高于EST组(40.0%vs 15.6%,42.9%vs 13.3%,均P<0.05);EPBD组高淀粉酶血症、胰腺炎发生率高于EST+EPBD组(40.0%vs 10.5%,42.9%vs 13.2%,均P<0.05);三组术后穿孔、出血、胆道感染发生率比较,差异均无统计学意义(P>0.05);EST+EPBD组胆道逆行感染、结石复发发生率低于EST组(5.3%vs 26.7%,2.6%vs 20.0%,均P<0.05)。EST+EPBD组一次取石成功率高于EST组(97.4%vs 77.8%,P<0.05);EST+EPBD组机械碎石率低于EST组(5.3%vs 26.7%,P<0.05);EPBD组手术时间少于EST组(P<0.05);EST+EPBD组手术时间少于EST组、EPBD组(P<0.05);三组残余结石率、住院时间比较,差异均无统计学意义(P>0.05)。治疗前和治疗后7 d,三组血清学指标WBC、PCT、CRP、COX-2、AMS、TBiL比较,差异均无统计学意义(P>0.05);三组治疗后7d的血清学指标,与治疗前比较差异均有统计学意义(P<0.05)。结论EST+EPBD治疗非扩张性肝外胆管结石疗效确切,近、远期并发症的发生率低,且不加重机体炎症应激反应,安全可行。Objective To compare the clinical efficacy and safety of endoscopic sphincterotomy(EST),endoscopic papillary balloon dilation(EPBD)and EST+EPBD in the treatment of non-dilated extrahepatic bile duct stones.Methods A retrospective study was performed on 118 patients with non-dilated extrahepatic bile duct stones who received endoscopic treatment in the First Affiliated Hospital of Shanxi Medical University from September 2020 to January 2022.According to the therapies they received,the patients were divided into EST group(n=45),EPBD group(n=35)and EST+EPBD group(n=38).The incidence of postoperative complications,perioperative related indexes,and serological indexes before and 7 days after operation were compared among 3 groups.Results The incidence of hyperamylasemia and Post-ERCP pancreatitis in EPBD group was higher than that in EST group(40.0%vs 15.6%,42.9%vs 13.3%),P<0.05.The incidence of hyperamylasemia and Post-ERCP pancreatitis in EPBD group was higher than that in EST+EPBD group(40.0%vs 10.5%,42.9%vs 13.2%),P<0.05;The incidence of postoperative perforation,bleeding and infection of biliary tract in 3 groups was compared,P>0.05;The incidence of biliary retrograde infection and stone recurrence in EST+EPBD group was lower than that in EST group(5.3%vs 26.7%,2.6%vs 20.0%),P<0.05;The successful rate of primary stone removal in EST+EPBD group was higher than that in EST group(97.4%vs 77.8%),P<0.05;The mechanical gravel rate in EST+EPBD group was lower than that in EST group(5.3%vs 26.7%),P<0.05;The operative time of EPBD group was shorter than that of EST group,P<0.05;The operative time of EST+EPBD group was shorter than that of EST group and EPBD group,P<0.05;Comparison of residual stone rate and hospitalization stays among 3 groups,P>0.05;Serological indexes of the three groups at 7 days after operation were compared with those before operation,P<0.05;Before operation,the serological indexes of the three groups were compared,P>0.05;At 7 days after operation,the serological indexes of the three groups were com

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 

分 类 号：R657.43[医药卫生—外科学] R575[医药卫生—临床医学]