内镜下小切开联合球囊扩张治疗十二指肠乳头旁憩室伴胆总管结石的临床疗效分析  

Analysis of clinical efficacy of minor endoscopic sphincterotomy combined with balloon dilatation on juxtapapillary duodenal diverticula with choledocholithiasis

作　　者：张科[1] 成翠娥[1] 肖龙[1] 王斌[1] ZHANG Ke;CHENG Cui-e;XIAO Long(Department of Gastroenterology,Changshu No.2 People's Hospital,Changshu 215500,China)

机构地区：[1]常熟市第二人民医院消化内科,215500

出　　处：《中国实用医药》2023年第19期30-34,共5页China Practical Medicine

基　　金：常熟市第二人民医院院级科技计划项目(项目编号:CSEY2021024)。

摘　　要：目的比较内镜下乳头括约肌小切开术(mEST)联合内镜下乳头球囊扩张术(EPBD)和内镜下乳头括约肌切开术(EST)治疗十二指肠乳头旁憩室(JPDD)伴胆总管结石的临床疗效及安全性。方法259例JPDD伴胆总管结石患者,按照手术方式不同分为EST组(125例)和mEST+EPBD组(134例)。EST组行EST治疗,mEST+EPBD组行mEST联合EPBD治疗。比较两组患者手术相关指标、住院时间以及并发症发生情况,不同大小憩室患者手术相关指标及并发症发生情况。结果259例患者中256例取石成功,总取石成功率为98.8%。两组患者总取石成功率、机械碎石率、住院时间比较差异无统计学意义(P>0.05);mEST+EPBD组患者一次性取石成功率95.52%高于EST组的81.60%,取石时间(20.7±5.0)min短于EST组的(24.2±2.8)min,差异具有统计学意义(P<0.05)。mEST+EPBD组患者并发症发生率为9.70%,低于EST组的20.80%,差异具有统计学意义(P<0.05)。mEST+EPBD组中JPDD<20 mm患者一次性取石成功率96.43%高于EST组中JPDD<20 mm患者的85.71%,取石时间(20.9±5.2)min短于EST组中JPDD<20 mm患者的(24.4±2.7)min,差异具有统计学意义(P<0.05)。mEST+EPBD组中JPDD≥20 mm患者一次性取石成功率90.91%高于EST组中JPDD≥20 mm患者的60.00%,取石时间(19.4±3.9)min短于EST组中JPDD≥20 mm患者的(23.2±3.0)min,并发症发生率22.73%低于EST组中JPDD≥20 mm患者的60.00%,差异具有统计学意义(P<0.05)。结论对比常规EST,JPDD伴胆总管结石行m EST联合EPBD治疗操作简单,能够提高取石成功率,缩短手术时间,降低因乳头大切开而引起的急性胰腺炎、出血、穿孔等严重早期并发症发生率。Objective To compare the clinical efficacy and safety of minor endoscopic sphincterotomy(mEST)combined with endoscopic papillary balloon dilatation(EPBD)and endoscopic sphincterotomy(EST)on juxtapapillary duodenal diverticula with choledocholithiasis.Methods A total of 259 cases of JPDD patients with choledocholithiasis were divided into EST group(125 cases)and mEST+EPBD group(134 cases)according to different surgical methods.EST group was treated with EST,and mEST+EPBD group was treated with mEST combined with EPBD.Comparison was made on surgery-related indicators,hospital stay and postoperative complications between the two groups,as well as patients with different sizes of diverticula.Results In 259 patients,the stones of 256 patients were successfully extracted,with a total success rate of 98.8%.There was no statistically significant difference in the total success rate of stone extraction,mechanical lithotripsy rate and hospital stay between the two groups(P>0.05).The success rate of one-time stone extraction of 95.52%in mEST+EPBD group was higher than that of 81.60%in EST group,and the stone extraction time of(20.7±5.0)min was shorter than that of(24.2±2.8)min in EST group.The differences were statistically significant(P<0.05).The total complication rate of mEST+EPBD group was 9.70%,which was lower than that of 20.80%of EST group,and the difference was statistically significant(P<0.05).The success rate of one-time stone extraction of 96.43%of patients with JPDD<20 mm in mEST+EPBD group was higher than that of 85.71%of patients with JPDD<20 mm in EST group,and the stone extraction time of(20.9±5.2)min was shorter than that of(24.4±2.7)min of patients with JPDD<20 mm in EST group.The differences were statistically significant(P<0.05).The success rate of one-time stone extraction of 90.91%of patients with JPDD≥20 mm in mEST+EPBD group was higher than that of 60.00%of patients with JPDD≥20 mm in EST group;the stone extraction time of(19.4±3.9)min of patients with JPDD≥20 mm in mEST+EPBD group was sho

关 键 词：十二指肠乳头旁憩室 胆总管结石 内镜下乳头括约肌小切开术 内镜下乳头球囊扩张术 临床疗效 

分 类 号：R657.42[医药卫生—外科学]