内镜下乳头球囊扩张术和乳头括约肌切开术治疗胆总管结石的有效性和安全性  

Effectiveness and safety of endoscopic papillary balloon dilatation and sphincterotomy for the treatment of common bile duct stones

作　　者：李素娟[1] 苏秉忠[1] 陈平[1] 黄应龙[1] LI Sujuan;SU Bingzhong;CHEN Ping;HUANG Yinglong(Department of Gastroenterology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院消化内科,呼和浩特010050

出　　处：《临床与病理杂志》2023年第8期1528-1532,共5页Journal of Clinical and Pathological Research

基　　金：内蒙古医科大学附属医院一般科研项目(NYFYYB001)。

摘　　要：目的:内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)是胆总管结石的经典治疗方法,但存在一些并发症。内镜下乳头球囊扩张术(endoscopic papillary balloon dilatation,EPBD)创伤小、并发症少、对乳头括约肌有保护作用,被认为是EST取石最有价值的替代方法。本研究旨在对比2种术式治疗胆总管结石的疗效和并发症,为个体化选择提供依据。方法:回顾性收集2021年1月1日至12月31日在内蒙古医科大学附属医院消化内科住院治疗的164胆总管结石患者的临床资料,按术式分为EPBD组(79例)和EST组(85例)。比较2组的有效性和近期及远期并发症。结果:与EST组相比,EPBD组的机械碎石率高(35.44%vs 20.00%);随访1年的远期并发症结石复发率低(2.53%vs 11.76%),差异均有统计学意义(均P<0.05);近期并发症中出血发生率低(1.26%vs 7.05%),但差异无统计学意义(P>0.05)。结论:与EST相比,EPBD术后出血发生率和结石复发率降低,结石清除率相近,提示EPBD可以作为胆总管结石患者的治疗选择,特别是对不适于EST的患者。Objective:Endoscopic sphincterotomy(EST)is a classic treatment method for common bile duct stones,but it is associated with some complications.Endoscopic papillary balloon dilation(EPBD)is considered the most valuable alternative method for EST due to minimal trauma,fewer complications,and protective role for the sphincter.This study aims to compare the efficacy and complications of 2 methods for treating common bile duct stones,providing a basis for individualized selection.Methods:From January 1,2021 to December 31,2021,the data of 164 patients with common bile duct stones who underwent successful EST and EPBD were respectively collected.The effectiveness,short-and long-term complications were compared between the 2 groups.Results:Compared with the EST group,the rate of mechanical lithotripsy was higher in the EPBD group(35.44%vs 20.00%),and the rate of stone recurrence was lower in the EPBD group at 1-year follow-up(2.53%vs 11.76%),with statistical significance(all P<0.05);the frequency of hemorrhage was lower in the EPBD group(1.26%vs 7.05%),but without statistical significance(P>0.05).Conclusion:Compared to EST,EPBD has a low incidence of hemorrhage and stone recurrence with a similar stone clearance rate.EPBD is considered as a treatment option for patients with cornmon bile duct stones,especially in those who are not suitable for EST.

关 键 词：胆总管结石 内镜下乳头括约肌切开术 内镜下乳头球囊扩张术 

分 类 号：R657.4[医药卫生—外科学]