内镜下乳头括约肌小切开联合气囊扩张术对胆总管结石患者并发症的作用

目的探讨内镜下乳头括约肌小切开联合乳头气囊扩张术(EPBD)在减少胆总管结石治疗近、远期并发症中的作用。方法选取我院胆总管结石患者73例,随机分为乳头括约肌小切开联合EPBD术取石组(n=38)和单纯乳头括约肌切开术(EST)取石组(n=35),观察两组的治愈率,近期、远期并发症情况。结果两组取石成功率分别为94.7%vs97.1%,无显著性差异(P(0.05);两组近期并发症(胰腺炎各1例,出血分别0例vs2例,胆道感染分别2例vs1例)发生率分别为7.9%和11.4%,无显著性差异(P0.05);远期并发症(反流性胆管炎分别1例、3例,结石复发分别1例vs6例)发生率分别为5.3%vs25.7%,有显著性差异(P0.05)。结论内镜下乳头括约肌小切开联合EPBD术扩大了胆总管结石治疗手术适应证,减少了手术的近期、远期并发症。     

十二指肠乳头括约肌小切开联合气囊扩张术治疗胆总管结石

经内镜乳头括约肌切开术（EST）取石用于治疗胆总管结石已得到广泛认可,但并发症发生率仍较高,经内镜乳头气囊扩张术（EPBD）取石具有与EST取石相近的成功率,出血、穿孔并发症相对较少,且保护了十二指肠乳头括约肌功能,但因球囊压迫胰管开口,术后胰腺炎的发生率相对较高。我们采用内镜下乳头括约肌小切开联合EPBD治疗了38例胆总管结石,现总结资料,探讨其有效性、安全性和在减少近期、远期并发症方面的作用。     

内镜下乳头括约肌小切开联合气囊扩张术治疗胆总管结石临床体会

目的 探讨内镜下乳头括约肌小切开联合乳头气囊扩张术(EPBD)治疗胆总管结石的效果.方法 对121例胆总管结石患者行乳头括约肌小切开联合EPBD后取石治疗.结果 2例结石太大转外科手术治疗,2例乳头插管未成功转外科手术治疗;83例一次完成取石,34例二次取石后取尽,取石成功率98％;并发胰腺炎2例,胆道感染1例,高淀粉酶血症11例.结论 内镜下乳头括约肌小切开联合EPBD术治疗胆总管结石效果确切,无严重并发症发生.     

内镜下乳头括约肌小切开联合乳头球囊扩张术治疗胆总管结石的临床分析

内镜下乳头括约肌切开术（EST）治疗胆总管结石已得到临床广泛认可,并成为治疗胆总管结石的首选方法,但该技术引起并发症的比例仍较高。单纯乳头球囊扩张术（EPBD）后取石具有与单纯EST术后取石相近的成功率,并发症少,创伤小,且对十二指肠乳头括约肌有保护功能,多数学者认为EPBD是EST的最有价值的替代方法,但因球囊压迫胰管开口,术后胰腺炎的发生率相对较高。如何在胆总管结石内镜取石中取得更好的疗效,如何减少内镜取石术近期、远期并发症？本研究采用内镜下乳头括约肌小切开联合EPBD术治疗胆总管结石,从手术成功率、疗效、并发症等方面对乳头括约肌小切开联合EPBD术和单纯EST术两者进行比较,旨在探讨该方法的临床应用价值和疗效。     

乳头括约肌小切开联合内镜下乳头球囊扩张术治疗胆总管结石患者疗效对比分析

目的探讨不同方案治疗胆总管结石患者的临床疗效。方法 2010年2月～2016年3月我院诊治的122例胆总管结石患者,采用随机数字表法分为联合组61例和对照组61例,分别采用乳头括约肌小切开联合内镜下柱状球囊扩张术或者内镜下括约肌切开术治疗,比较两组疗效和并发症发生情况。结果在61例联合组患者中,57例(93.4%),在61例对照组患者中,56例(91.8%)患者成功取石(P0.05);两组近期并发症发生率无显著性相差(P0.05),术后6个月,两组患者结石复发率和反流性胆管炎发生率也无显著性差异(P0.05)。结论采用乳头括约肌小切开联合柱状球囊扩张术治疗胆总管结石患者,对于较大的结石取石更有效,更方便。     

内镜下十二指肠乳头小切开后球囊扩张术治疗胆总管结石的临床研究

目的探讨内镜下十二指肠乳头括约肌小切开后球囊扩张术在胆总管结石治疗中的有效性和安全性。方法将150例临床确诊为胆总管结石的患者随机分为乳头括约肌切开组(EST组)和乳头括约肌小切开后球囊扩张术组(SEST+EPBD组),比较两组疗效及并发症的发生率。结果 EST组和SEST+EPBD组取石成功率分别为92%和97%(χ2=1.19,P0.05)。EST组术后出现急性胰腺炎2例,出血4例,结石复发11例,逆行性胆道感染15例。SEST+EPBD组术后出现急性胰腺炎1例,出血1例,结石复发2例,逆行性胆道感染6例。两组取石成功率及近期并发症比较差异无统计学意义(P0.05),远期并发症比较差异有统计学意义(P0.05)。结论内镜下乳头括约肌小切开后球囊扩张术治疗胆总管结石安全、有效,并发症少,并且尽可能的保留了十二指肠乳头括约肌的功能,值得临床推广。     

内镜下十二指肠乳头括约肌小切开联合气囊扩张术治疗胆总管结石的价值

十二指肠镜下行十二指肠乳头括约肌切开术（EST）或气囊扩张术（EPBD）治疗肝外胆管结石，由于其微创性、安全性、有效性以及并发症少等优势，得到了人们的广泛认可。但是 EST 治疗胆总管结石所引起的并发症，如出血、穿孔、胰腺炎、胆管炎和十二指肠乳头括约肌受损导致的反流性胆管炎和结石复发等，发病率仍较高。而 EPBD 虽可以保护十二指肠乳头括约肌功能，具有较高的取石成功率，术后并发症如出血、穿孔等亦较 EST 少，但因气囊压迫胰管开口，术后急性胰腺炎的发生率相对较高［1］，使其应用受到一定限制。如何在胆总管结石内镜取石中取得更好的疗效，并减少术后并发症已经成为广大临床工作者的研究重点。本文采用内镜下乳头括约肌小切开联合 EPBD 治疗胆总管结石，旨在探讨该方法的应用价值。     

乳头括约肌小切口联合球囊扩张治疗胆总管结石的疗效及安全性

目的探究胆总管结石患者采取乳头括约肌小切口联合球囊扩张治疗术(EPBD)的临床疗效及安全性。方法选取我院消化科收治的72例胆总管结石患者,随机分为研究组和对照组,每组各36例。其中对照组进行单纯乳头括约肌切开术(EST),研究组行乳头括约肌小切口联合EPBD治疗。对比两组患者取石成功率及近远期并发症发生率。结果研究组取石成功率为97.2%,对照组为88.9%,差异有统计学意义(P0.05)。两组近期并发症发生率差异无统计学意义(P0.05)。研究组远期并发症发生率低于对照组,差异有统计学意义(P0.05)。结论乳头括约肌小切口联合EPBD术较EST术应用于胆总管结石患者,能够提高取石成功率,且安全性更佳,值得在临床上进一步推广。     

十二指肠乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的疗效评价

目的 探讨乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的效果和安全性.方法 将2008年3月至2009年12月收治的难治性胆总管结石患者随机分为两组,分别为乳头括约肌切开组及乳头括约肌小切开联合气囊扩张组,比较两组间结石取净率、取石次数、机械碎石使用率、并发症发生率.结果 两组间结石取净率、早期并发症发生率,差异无统计学意义（2/61比2/62,6/61比4/62;P＞0.05）;乳头括约肌切开组需多次及需要使用机械碎石才能取净结石的比例以高于乳头括约肌小切开联合气囊扩张组,率差异有统计学意义（15/61比5/62,12/6l比4/62;P＜0.05）.结论 乳头括约肌小切开联合气囊扩张与乳头括约肌切开两种方法同样安全有效;乳头括约肌小切开联合气囊扩张操作更简便.     

单纯十二指肠乳头气囊扩张治疗胆总管结石合并乳头旁憩室的安全性

目的评价内镜下单纯十二指肠乳头气囊扩张(EPBD)治疗胆总管结石合并乳头旁憩室的安全性。方法对65例胆总管结石合并十二指肠乳头旁憩室患者进行内镜下取石治疗,其中35例行单纯EPBD术后取石,30例行十二指肠乳头括约肌小切开(sEST)联合EPBD取石。比较两组取石取净率、术中出血情况及并发症。结果两组取石取净率差异无统计学意义(P0.05);单纯EPBD组术后无出血,明显少于EST+EPBD组(P=0.04)。术后胰腺炎及胆管炎相当,差异无统计学意义,两组均未发生穿孔。结论单纯EPBD术治疗胆总管结石合并十二指肠乳头旁憩室比EST联合EPBD安全,且操作方便,能够减少十二指肠乳头出血的风险。     

内镜下十二指肠乳头括约肌小切开术联合球囊扩张术治疗胆管结石的疗效观察

目的 探讨内镜下乳头括约肌小切开术（smallendoscopicsphincterotomy,SEST）联合球囊扩张术（endo—scopicpapillaryballoondilatation,EPBD）治疗胆管结石的远期疗效和并发症。方法选择青岛市海慈医疗集团消化内科2009年3月至2011年12月住院治疗的127例结石直径〉10mm的胆管结石患者,随机分为4组,SEST＋EPBD组33例,先行乳头括约肌小切开（切开范围小于乳头肌三分之一）,然后球囊扩张,再碎石取石;EPBD＋SEST组32例,先行球囊扩张术,再行乳头括约肌小切开,再碎石取石;EST组32例,仅行十二指肠乳头括约肌大切开（切开范围大于乳头肌三分之二）取石;EPBD组30例,仅行球囊扩张碎石取石。比较4组的疗效和并发症发生率。结果SEST＋EPBD组术后结石取净率为93．93％（31／33）,EPBD＋SEST组为93．75％（30／32）,EST组为96．77％（30／31）,EPBD组为66．67％（20／30）,EPBD组与其他三组比较差异有统计学意义（P〈0．05）;SEST＋EPBD组和EPBD＋SEST组均无远期并发症发生,EST组远期并发症发生率为16．67％,EPBD组为3．57％,EST组与其他三组比较有显著性差异（P〈0．05）。结论SEST与EPBD联合治疗胆管结石安全有效,可有效降低经内镜治疗胆管结石的远期并发症发生率,提高胆管结石患者术后的生活质量。     

十二指肠镜2种方法治疗胆管结石的比较

目的比较分析内镜下十二指肠乳头括约肌切开术（EST）和十二指肠乳头球囊扩张术（EPBD）治疗胆总管结石的临床疗效。方法选取河池市人民医院及右江民族医学院附属医院2010年3月2011年10月住院治疗的60例胆管结石患者,其中38例进行EST治疗,22例进行EPBD治疗．比较两组的疗效及并发症的发生率。结果EST组术后结石取净率为94．74％,EPBD组为95．45％．两者比较差异无统计学意义（x2=0．015,P〉0．05）;EST组近期并发症的发生率为5．56％明显低于EPBD组的23．80％（X2=4．102,P〈0．05）;EPBD组胰腺炎的发生率为19．04％明显高于EST组的2．78％（X2=4．387,P〈0．05）。EST组远期并发症的发生率为19．4％,而EPBD组未出现远期并发症,二者有显著性差异（x2=4．655,P〈0．05）。结论EST术和EPBD术治疗胆总管结石的结石清除率接近,但EST的并发症特别是术后胰腺炎的发生率较低,而EPBD的远期并发症较低,说明两种方法各有利弊,但均安全有效,临床应根据患者结石数目和结石大小选择适合的手术方式。     

经内镜乳头括约肌切开术与气囊扩张术治疗胆总管结石临床评价

目的:评价经内镜乳头括约肌切开术(EST)和气囊扩张术(EPBD)联合机械碎石(EML)治疗胆总管结石的临床疗效．方法:选取我院住院胆总管结石患者60例,随机分成EST组(n=30)和EPBD组(n=30),分别采用EST和EPBD联合机械碎石进行内镜下取石．观察二组的治愈率,近期并发症、远期并发症．结果:正结果EST组与EPBD组的取石成功率为93．3％和90％．无显著性差异(P>0．05): 两组近期并发症发生率(包括胰腺炎、胆道感染、出血)为30％和13．3％,无显著性差异 (P>0．05);而远期并发症(包括胆道感染、结石复发)26．7％和3.3％,有显著性差异(P<0．05)．结论:EST和EPBD的结石清除率及近期并发症相似,但EPBD远期并发症的发病率较低, 表明EPBD能够在一定程度上保护Oddi括约肌功能。     

Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones

Background This study was designed to evaluate the therapeutic outcome and early postoperative complications, especially pancreatitis, of endoscopic papillary balloon dilation (EPBD) and endoscopic sphincterotomy (EST) in patients with common bile duct stones in our department. Methods One hundred eighty patients with common bile duct stones were randomized to undergo EPBD or EST. An 8-mm dilatation balloon was used for EPBD. Modified Cotton's criteria, in which relatively mild pancreatitis is also included as a complication, were used to determine the incidence of postoperative complications. Results The rate of complete removal of stones was significantly higher in the EST group (95.6%) than in the EPBD group (86.6%); for stones less than 10 mm in diameter, however, the rate with EPBD (93.8%) was almost equivalent to that with EST (98.1%). According to modified Cotton's criteria, the incidence of postoperative pancreatitis was significantly higher in the EPBD group (16.7%) than in the EST group (6.7%). Bleeding was encountered in one patient (1.1%) in the EST group, but in none in the EPBD group. No fatal complication occurred in either the EPBD or the EST group. Conclusions Although EPBD appears to be comparable to EST for removal of small common bile duct stones, mild postoperative pancreatitis is more likely to occur with EPBD than with EST.     

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比较

目的 探讨内镜下乳头球囊扩张术(EPBD)治疗胆总管结石的有效性和安全性.方法 2005年6月至2007年5月山东大学齐鲁医院320例拟行内镜下取石的胆总管结石患者,随机分为EPBD组及内镜下乳头括约肌切开术(EST)组,每组160例.EPBD组在乳头球囊扩张后用取石网篮或气囊取石,当结石较大时先行机械碎石网篮碎石后再取石;EST组按常规操作.两组术后均常规鼻胆管引流3 d,并造影复查.结果 EST组及EPBD组分别有156例(97.5%)及157例(98.1%)成功取净结石,其中各有112例(70.0%)及104例(65.0%)一次完成;机械碎石网篮应用比例分别为20.0%(32/160)和22.5%(36/160);术后早期并发症的总发生率分别为5.6%及8.1%,无死亡病例.随访3年,EST组胆管结石复发率(7.5%)高于EPBD组(2.5%),P＜0.05.结论 EPBD取石具有与EST取石相近的成功率,经术后常规鼻胆管引流处理后,胰腺炎发生率无明显升高.EPBD可以作为胆总管结石的备选治疗措施,尤其是对不适于EST的患者.

Abstract：

Objective To explore the effectiveness and safety of endoscopic papillary balloon dilation( EPBD ) for the removal of common bile duct stones. Methods Three hundred and twenty consecutive patients with common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) who met all eligibility criteria were randomly assigned endoscopic sphincterotomy (EST) or EPBD.Complications were classified by an expert panel unaware of treatment allocation and outcome. Results After a single ERCP, all stones were removed from 112 patients ( 70% ) assigned EST and 104 ( 65% )assigned EPBD. Mechanical lithotripsy was used to fragment stones in 36 (22. 5% ) EPBD procedures and 32 ( 20. 0% ) EST procedures. Early complications occurred in 5.6% EST patients and 8.1% EPBD patients. No patient died. Gallstone disease recurrence, which is a long-term complication, is 7. 5% ( 12/160) in EST patients and 2.5% (4/160) in EPBD patients, P ＜0. 05. Conclusions The success rate of EPBD was similar to that of EST. We found no evidence of previously suggested higher risk of pancreatitis with EPBD, and suggest that EPBD is preferred in patients who are not suitable for EST, such as those with high risk of bleeding. This procedure is a valuable alternative to EST in patients with bile duct stones.     

改良内镜下乳头气囊扩张术应用的可行性研究

目的探讨改良内镜下乳头气囊扩张术（EPBD）治疗胆管结石的可行性。方法对226例肝外胆管结石的患者应用肠道型柱状气囊行乳头扩张并在此基础上展开治疗，并比较2299例内镜乳头切开术（EST）的治疗效果及术后并发症情况。结果226例患者均顺利完成取石或碎石取石术，术后无胆道感染、穿孔等并发症，发生轻型急性胰腺炎4．7％（10例），与EST（5．2％）比较，差异无统计学意义，术后消化道出血0．47％（1例），与EST（1．2％）比较，差异有统计学意义。结论对EST困难或易发生并发症者用肠道型柱状气囊行EPBD术，能有效地钝性切割乳头，并在此基础上展开较大结石的取石或碎石取石术，同时并发症明显减少。EPBD是内镜下处理胆管结石安全有效的方法之一。     

Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials

OBJECTIVES: To compare the effect of endoscopic balloon dilation (EPBD) of the papilla with that of endoscopic biliary sphincterotomy (EST) in the treatment of patients with common bile duct stones. METHODS: Searches of computerized bibliographic and scientific citations, and review of citations in relevant primary articles. Eight fully published prospective, randomized trials in English that compared EPBD with EST for the removal of common bile duct stones were subjected to metaanalysis. RESULTS: EPBD compared with EST resulted in similar outcomes with regards to overall successful stone removal (94.3% vs 96.5%) and overall complications (10.5% vs 10.3%). Bleeding occurred less frequently with EPBD (0% vs 2.0%, p = 0.001). Post-ERCP pancreatitis occurred more commonly in the EPBD group (7.4% vs 4.3%, p = 0.05). No significant differences were seen in the rates of perforation or infection. Patients undergoing EPBD were more likely to require mechanical lithotripsy for stone extraction (20.9% vs 14.8%, p = 0.014). CONCLUSIONS: On the basis of lower rates of bleeding, EPBD should be the preferred strategy over EST for endoscopic removal of common bile duct stones in patients with coagulopathy. Although EPBD is theoretically attractive for use in young patients for biliary sphincter preservation, the rate of pancreatitis is higher with EPBD and cannot be routinely recommended at this time.     

What is an appropriate indication for endoscopic papillary balloon dilation?

OBJECTIVE: There are a number of views on the indication for endoscopic papillary balloon dilation (EPBD) in the management of bile duct stones. In this study, we have evaluated the efficacy and safety of EPBD compared with endoscopic sphincterotomy (EST). DESIGN: Prospective randomized trial. SETTING: One university hospital and one general hospital. PARTICIPANTS AND MAIN OUTCOME MEASURES: One hundred and forty patients were randomly allocated to EPBD or EST. Outcomes and complications were observed for a median period of 30 months. RESULTS: Both treatment approaches finally achieved similar success rates and needed similar numbers of treatment sessions for patients with stones less than 10 mm in diameter. However, for patients with stones of 10 mm or more, EPBD required a significantly greater mean number of treatment sessions than EST (2.4 vs 1.6, P < 0.01). Early complications occurred in seven EPBD (four pancreatitis, two cholangitis and one basket impaction) and eight EST (three pancreatitis, two bleeding and three cholangitis) patients. Late complications occurred in four EPBD (three recurrent bile duct stones and one cholecystitis) and six EST (three recurrent stones and three cholecystitis) patients. CONCLUSIONS: EPBD has little risk of bleeding. The technique removed small bile duct stones just as easily as did EST. These two procedures had approximately the same risk of pancreatitis and incidence of recurrent bile duct stones. Therefore, both procedures appear to be appropriate treatments for small bile duct stones. Whether or not EPBD becomes an established treatment will depend on further long-term studies.