ESPBD与EST治疗肝硬化合并胆总管结石患者疗效比较  

Efficacy comparison of ESPBD and EST in the treatment of compensated liver cirrhotics with choledocholithiasis

作　　者：刘明 王金婷 杨士彦 杨位轩 万元春 Liu Ming;Wang Jinting;Yang ShiYan(Department of Gastroenterology,Fifth People's Hospital,Huai'an 223300,Jiangsu Province,China)

机构地区：[1]江苏省淮安市第五人民医院消化内科,223300 [2]徐州医科大学附属淮安医院消化内科

出　　处：《实用肝脏病杂志》2023年第6期915-918,共4页Journal of Practical Hepatology

基　　金：江苏省科技厅重点研发计划面上项目(编号:BE2019698)。

摘　　要：目的研究采用内镜下十二指肠乳头括约肌小切开联合球囊扩张术(ESPBD)与内镜下十二指肠乳头括约肌切开术(EST)治疗肝硬化合并胆总管结石患者的疗效。方法2018年3月~2022年3月我院收治的代偿期肝硬化合并胆总管结石患者112例,其中56例对照组接受EST治疗,另56例观察组接受ESPBD治疗。采用ELISA法检测血清皮质醇(COR)、去甲肾上腺素(NE)和肾上腺素(E)水平。结果观察组一次取石成功率为96.4%,显著高于对照组为80.4%(P<0.05);观察组术中出血量、手术时间、肛门排气时间和术后住院时间分别为(25.3±3.1)mL、(41.8±5.1)min、(24.3±4.6)h和(8.1±1.6)d,与对照组【分别为(27.9±2.8)mL、(44.9±4.9)min、(25.7±6.9)h和(7.8±2.1)d】比,差异无统计学意义(P>0.05);在术后7 d,观察组血清TBIL、ALT、ALB和GGT水平分别为(15.4±3.6)μmol/L、(29.6±5.7)U/L、(36.3±6.9)g/L和(94.2±5.2)U/L,与对照组的(14.8±2.9)μmol/L、(30.2±6.8)U/L、(37.1±5.8)g/L和(96.1±6.3)U/L比,无显著性差异(P>0.05);观察组血清COR、NE和E水平分别为(129.7±18.2)pg/mL、(415.1±51.6)pg/mL和(24.4±3.9)pg/mL,与对照组的(135.9±21.6)pg/mL、(422.7±53.9)pg/mL和(25.9±4.1)pg/mL比,无显著性差异(P>0.05);术后,观察组并发症,如切口感染、胰腺炎、腹腔出血、胆漏和高淀粉酶血症发生率为14.3%,显著低于对照组的30.4%(P<0.05)。结论与EST术比,采用ESPBD治疗肝硬化合并胆总管结石患者能提高一次性取石成功率,减少术后并发症的发生,而不会增加应急反应。Objective The aim of this study was to investigate the efficacy of limited endoscopic sphincterotomy with balloon dilation(ESPBD)and endoscopic sphincterotomy(EST)in the treatment of patients with liver cirrhosis common bile duct stones.Methods 112 patients with compensated liver cirrhosis and choledolithiasis were admitted to our hospital between March 2018 and March 2022,and 56 patients in the control were treated with EST and another 56 in the observation group were treated with ESPBD.Serum cortisol(COR),norepinephrine(NE)and epinephrine(E)levels were detected by ELISA.Results The successful rate of one time stone removal in the observation group was 96.4%,significantly higher than 80.4%in the control group(P<0.05);the intra-operational blood loss,operation time,exhaust time and hospital stay in the observation group were(25.3±3.1)mL,(41.8±5.1)min,(24.3±4.6)h and(8.1±1.6)d,not significantly different compared to[(27.9±2.8)mL,(44.9±4.9)min,(25.7±6.9)h and(7.8±2.1)d]in the control(P>0.05);7 day after operation,total serum bilirubin,serum alanine aminotransferase,albumin and glutamyl transpeptidease levels in the observation were(15.4±3.6)μmol/L,(29.6±5.7)U/L,(36.3±6.9)g/L and(94.2±5.2)U/L,not significantly different compared to(14.8±2.9)μmol/L,(30.2±6.8)U/L,(37.1±5.8)g/L and(96.1±6.3)U/L in the control(P>0.05);serum COR,NE and E levels were(129.7±18.2)pg/mL,(415.1±51.6)pg/mL and(24.4±3.9)pg/mL,not significantly different compared to(135.9±21.6)pg/mL,(422.7±53.9)pg/mL and(25.9±4.1)pg/mL in the control(P>0.05);post-operationally,the incidence of complications,such as infection,pancreatitis,intraperitoneal bleeding,bile leak and hyperamylasemia in the observation was 14.3%,much lower than 30.4%(P<0.05)in the control group.Conclusion Compared with EST treatment,the application of ESPBD in the treatment of patients with liver cirrhosis and choledocholithiasis is efficacious with high one-time successful rate of stone removal and less postoperative complications.

关 键 词：胆总管结石 肝硬化 内镜下十二指肠乳头括约肌切开术 内镜下十二指肠乳头括约肌小切开联合球囊扩张术 治疗 

分 类 号：R657.42[医药卫生—外科学] R657.31[医药卫生—临床医学]