内镜下乳头括约肌小切口联合大口径气囊扩张术治疗胆总管结石的研究

目的探讨内镜下十二指肠乳头小切开联合大口径气囊扩张治疗大胆总管结石的安全性及治疗价值。方法对比分析2005年6月至2012年2月我院胆总管结石直径≥10mm患者行内镜下十二指肠乳头小切开联合大口径气囊扩张取石与传统内镜下乳头括约肌切开取石的治疗效果与近期并发症。结果 159名入选病例中一期成功清除结石130例（81.8%）;其中A组为110例（89.4%）,B组为120例（88.2%）,A组中机械碎石30例（24.4%）,B组为32例（23.7%）,两组间一期结石清除率和机械碎石率没有差异（P〉0.05）;但A组平均操作时间明显长于B组（P〈0.05）。A组术后出血11例（8.9%）,B组2例（5.9%）;A组3例（2.4%）出现穿孔,B组1例（0.7%）,A组术后胆管炎8例（6.5%）,B组有2例（1.5%）,A组出血、穿孔和胆管炎的发生率明显高于B组（P〈0.05）;两组均未发生术后胰腺炎,A组高淀粉酶血症35例（28.5%）,B组42例（30.9%）,组间无差异（P〉0.05）。结论 sEST＋EPLBD和传统EST相比,在治疗胆总管大结石方面同样有效的,但操作时间更短,更安全。

Clinical study of endoscopic papillary large balloon dilation with small endoscopic sphincterotomy in treatment of large common bile duct stones

Objective To study the safety and therapeutic value of small sphincterotomy combined with endoscopic papillary large balloon dilation for large bile duct stones.Methods We compared the therapeutic effect and recent complications prospectively of sEST＋EPLBD（group B,n=136）with conventional EST（group A,n=123）for the treatment of large（≥10mm）bile duct stones.Results The complete stone removal rate with one session was 81.8% overall,89.4% in group A and 88.2% in group B respectively.The mechanical lithotripsy was required for stone removal in 30 of 123 patients（24.4%）in group A and 32 of 136 patients（23.5%）in group B.No significant differences were observed between the rates of complete stone removal,mechanical lithotripsy between the two groups（P〈0.05）.The average procedure time of group A is longer than that of group B（P〈0.05）.The recent complications,such as hemorrhage,perforation and cholangitis,of group A were Significantly higher than that of group B（P〉0.05）.Conclusion Compared to conventional EST,sEST＋EPLBD was equally effective,but safer and more efficient,especially for the removal of large bile duct stones.