sEST联合不同扩张时间EPBD治疗胆总管结石的随机临床试验  

Randomized clinical trial of sEST combined with EPBD at different dilation times in the treatment of choledocholithiasis

作　　者：张立一 徐春晓 单玉玺 Zhang Liyi;Xu Chunxiao;Shan Yuxi(Department of Gastroenterology,Jiaozhou Central Hospital of Qingdao,Qingdao Shandong Province 266300,China)

机构地区：[1]青岛市胶州中心医院,山东青岛266300

出　　处：《中华普外科手术学杂志（电子版）》2024年第3期295-298,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2022年度青岛市医药卫生科研指导项目(2022-WJZD122);2022-2024年青岛市市级临床重点专科胃肠道肿瘤综合治疗专科资助。

摘　　要：目的研究内镜乳头括约肌小切开(sEST)联合不同扩张时间内镜乳头括约肌柱状球囊扩张(EPBD)治疗胆总管结石的临床效果。方法前瞻性随机选取2017年1月到2023年6月收治的胆总管结石患者80例,所有患者均行sEST联合EPBD治疗,采用随机数字表法分为两组,每组各40例,内镜下乳头括约肌小切开后球囊扩张时间30s的患者为30s组,球囊扩张时间60s的患者为60s组。采用SPSS 24.0行数据分析。两组患者手术情况、血淀粉酶水平、血清总胆红素(TBiL)和直接胆红素(DBiL)水平等计量资料用(x±s)表示,行独立样本t检验,术后并发症发生情况比较行χ^(2)检验。P<0.05表示差异具有统计学意义。结果30s组患者住院时间显著短于60s组(P<0.05)。术后24h,两组患者血淀粉酶水平较术前更高(P<0.05),但30s组显著低于60s组(P<0.05);术后24h,两组患者TBiL和DBiL较术前均降低(P<0.05),但两组间差异无统计学意义(P>0.05)。30s组患者并发症总发生率显著低于60s组(7.50%vs.25.0%,P<0.05),其中出血发生率显著低于60s组(2.5%vs.20.0%,P<0.05)。结论sEST联合EPBD治疗胆总管结石具有良好取石成功率,EPBD扩张时间为30s能降低患者术后24h血淀粉酶水平和术后出血发生率,值得推荐。Objective To study the clinical effect of small endoscopic sphincterotomy(sEST)combined with endoscopic papillary balloon dilation(EPBD)at different dilation times in the treatment of choledocholithiasis.Methods A total of 80 patients with choledocholithiasis from January 2017 to June 2023 were randomly prospectively selected.All patients were treated with sEST combined with EPBD.The patients were divided into two groups according to the random number table method,with 40 cases in each group.The 30s group performed balloon dilatation for 30s after sEST,while the 60s group received balloon dilatation for 60s after sEST.SPSS 24.0 was used for data analysis.Measurement data such as surgical situation,serum amylase level,serum total bilirubin(TBiL)and direct bilirubin(DBiL)of the two groups were expressed as(x±s)and compared by independent t test.The postoperative complications between the two groups were compared by chi-square test.P<0.05 was considered statistically significant.Results The length of hospitalization in 30s group was significantly shorter than that in 60s group(P<0.05).At 24h after surgery,the blood amylase levels in both groups were higher than before surgery(P<0.05),but the level in 30s group was significantly lower than that in 60s group(P<0.05).The levels of TBiL and DBiL in both groups at 24h after surgery were declined compared with those before surgery(P<0.05),but there were no statistical differences between groups(P>0.05).The total incidence rate of complications in 30s group was significantly lower than that in 60s group(7.50%vs.25.0%,P<0.05),and the bleeding rate was significantly lower than that in 60s group(2.5%vs.20.0%,P<0.05).Conclusion sEST combined with EPBD in the treatment of patients with choledocholithiasis has a good success rate of stone removal.EPBD with dilation time of 30s can reduce the blood amylase level at 24h after surgery and the incidence rate of postoperative bleeding.

关 键 词：胆总管结石 胆总管取石术 内镜乳头括约肌小切开 内镜乳头括约肌柱状球囊扩张 并发症 

分 类 号：R657.4[医药卫生—外科学]