内镜下乳头括约肌小切开联合球囊扩张术治疗肝硬化合并胆总管结石的疗效观察

目的评价内镜下十二指肠乳头括约肌小切开联合球囊扩张术（ESBD）治疗肝硬化合并胆总管结石的有效性及安全性。方法回顾性对比分析79例接受ESBD治疗（ESBD组）和42例接受十二指肠乳头球囊扩张术（EPBD）治疗（EPBD组）的肝硬化合并胆总管结石患者的结石清除情况和并发症发生情况。结果ESBD组结石完全清除率和一次性完全清除率分别为94．9％（75／79）和77．2％（61／79），EPBD组分别为88．1％（37／42）和59．5％（25／42），ESBD组结石完全清除率略高于EPBD组（P=0．317），但结石一次性完全清除率明显高于EPBD组（P=0．041）。ESBD组发生ERCP相关性出血3例（3．8％），术后高淀粉酶血症3例（3．8％），术后急性胰腺炎2例（2．5％）；EPBD组未发生ERCP相关性出血，发生术后高淀粉酶血症8例（19．0％）、术后急性胰腺炎6例（14．3％）。2组比较，ERCP相关性出血发生率差异无统计学意义（P=0．551），但ESBD组术后高淀粉酶血症和术后急性胰腺炎发生率均明显低于EPBD组（P〈0．05）。结论ESBD治疗肝硬化合并胆总管结石安全有效，能提高EPBD的取石效果，减少术后高淀粉酶血症和急性胰腺炎的发生，并且不会明显增加ERCP相关性出血风险。

Endoscopic sphincteropapillotomy combined with balloon dilation for cirrhosis accompanied with

Objective To study the clincial effectiveness and safety of endoscopic sphincteropapil- lotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis. Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent lim- ited endoscopic sphincterotomy plus endoscopic papillary balloon dilation （ESBD, the ESBD group） and 42 cases who underwent endoscopic papillary balloon dilation（ EPBD, the EPBD group）were retrospectively analysed and compared for complete stone clearance rate, one-time stone clearance rate and complications. Results The rate of complete stone clearance and one-time stone clearance were 94. 9% （ 75/79 ） and 77.2% （61/79）in ESBD group, and those were 88. 1% （37/42）and 59.5% （25/42）in EPBD group re- spectively. The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group. In ESBD group, ERCP-related bleeding occurred in 3 patients （3.8%）, post-ERCP hyperamylasemia in 3（3.8% ）and post-ERCP pancreatitis in 2 （2. 5% ） ; while in EPBD group, post-ERCP hyperamylasemia occurred in 8 patients（ 19. 0% ）, post-ERCP pancreatitis in 6（ 14. 3% ） and ERCP-related bleeding did not occur. There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group （P = 0. 551 ）. However, the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were sig- nificantly lower than those in EPBD group （P 〈 0. 05）. Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis, with several advantages over EPBD in termsof higher one-time stone clearance rate, reduced risk of post-ERCP pancreatitis and hyperamylasemia, and without noticeable increase in the risk of bleeding related to ERCP.