不同取石策略的内镜逆行胰胆管造影术治疗胆总管结石疗效比较  

Comparison of the efficacy of different stone extraction strategies in endoscopic retrograde cholangiopancrea-tography for choledocholithiasis treatment

作　　者：吴李飞 张焰平[1] 汪祺[1] 徐伟 陈燕[1] 秦万节 WU Lifei;ZHANG Yanping;WANG Qi;XU Wei;CHEN Yan;QIN Wanjie(Department of Gastroenterology,Anqing Municipal Hospital,Anqing 246003,Anhui Province,China)

机构地区：[1]安庆市立医院消化内科,安徽安庆246003

出　　处：《新乡医学院学报》2025年第3期213-218,共6页Journal of Xinxiang Medical University

基　　金：安徽省第六批卫生健康适宜技术推广项目(编号:SYJS202109)。

摘　　要：目的对比不同取石策略的内镜逆行胰胆管造影术(ERCP)治疗胆总管结石的疗效及安全性。方法选择2021年1月至2023年12月安庆市立医院收治的271例胆总管结石患者为研究对象。根据治疗方式将患者分为内镜下乳头球囊扩张术(EPBD)组(n=90)、内镜下乳头括约肌小切开联合球囊扩张术(ESBD)组(n=91)和ESBD+机械碎石组(n=90),3组患者均在ERCP下行取石术。记录3组患者首次取石成功率、术中出血情况及手术时间。采用视觉模拟评分法(VAS)评估3组患者术后6、12、24 h时的疼痛程度。记录3组患者术后首次排气及排便时间、肠鸣音恢复时间。采集3组患者术前、术后1 d空腹静脉血4 mL,采用全自动生化分析仪测血清直接胆红素(DBIL)、丙氨酸转氨酶(ALT)及总胆红素(TBIL)水平。记录3组患者随访期间术后并发症发生情况。结果3组患者首次取石成功率、术中出血率比较差异均无统计学意义(P>0.05)。ESBD组、ESBD+机械碎石组患者的手术时间显著长于EPBD组(P<0.05),ESBD+机械碎石组患者的手术时间显著长于ESBD组(P<0.05)。术后6、12、24 h,3组患者的VAS评分比较差异均无统计学意义(P>0.05)。3组患者术后12 h时的VAS评分均显著高于术后6 h(P<0.05);3组患者术后24 h时的VAS评分均显著低于术后6 h和术后12 h(P<0.05)。3组患者的肠鸣音恢复时间、首次排气时间和首次排便时间比较差异均无统计学意义(P>0.05)。术前,3组患者血清DBIL、TBIL及ALT水平比较差异无统计学意义(P>0.05)。术后1 d,3组患者血清DBIL、TBIL及ALT水平均显著低于术前(P<0.05),但3组间比较差异无统计学意义(P>0.05)。3组患者胆管感染、消化道出血及穿孔、胰腺炎、反流性胆管炎、结石复发等术后并发症发生率比较差异均无统计学意义(χ^(2)=1.288、0.824、4.630、0.666、0.775,P>0.05)。结论不同取石策略的ERCP治疗胆总管结石均取得了良好的临床疗效,对胃肠功能�Objective To compare the efficacy and safety of different stone extraction strategies in endoscopic retrograde cholangiopancreatography(ERCP)for choledocholithiasis treatment.Methods A total of 271 patients with choledocholithiasis admitted to Anqing Municipal Hospital from January 2021 to December 2023 were selected and divided into an endoscopic papillary balloon dilation(EPBD)group(n=90),a limited endoscopic sphincterotomy combined with balloon dilation(ESBD)group(n=91)and an ESBD+mechanical lithotripsy group(n=90)according to the treatment approach.All the patients of the three groups underwent stone extraction under ERCP.The first-time stone removal success rate,intraoperative bleeding,and operative duration were recorded for all the three groups.The visual analog scale(VAS)was used to assess pain levels 6,12,and 24 hours postoperatively among the three groups.The first postoperative flatus and defecation times and the recovery time of bowel sounds were recorded for all patients.Four milliliters of fasting venous blood was collected from each patient before surgery and one day after surgery.A fully automatic biochemical analyzer was used to measure serum levels of direct bilirubin(DBIL),alanine aminotransferase(ALT),and total bilirubin(TBIL).The occurrence of postoperative complications during the follow-up period was recorded for all the three groups.Results There were no statistically significant differences in the first-time stone removal success rate and intraoperative bleeding among the three groups(P>0.05).The operative duration was significantly longer in the ESBD group and the ESBD+mechanical lithotripsy group than that in the EPBD group(P<0.05).The operative duration was significantly longer in the ESBD+mechanical lithotripsy group than that in the ESBD group(P<0.05).At 6,12,and 24 hours postoperatively,there were no statistically significant differences in VAS scores among the three groups(P>0.05).The VAS scores of all the three groups at 12 hours postoperatively were significantly higher than thos

关 键 词：胆总管结石 内镜逆行胰胆管造影 内镜括约肌切开术 复发 安全性 

分 类 号：R657.42[医药卫生—外科学]