内镜下乳头小切开加球囊扩张术治疗胆总管大结石80例

目的:探讨内镜下乳头小切开加球囊扩张术治疗胆总管大结石的有效性和安全性.方法:2010-01/2011-10我院消化内科住院行内镜下取石的胆总管结石直径>1.2cm的患者,随机分为内镜下乳头括约肌切开术(EST)组及内镜下乳头小切开加球囊扩张术(ESBD)组,每组40例.ESBD组在先行乳头小切开后行乳头球囊扩张;EST组按常规操作.结果:EST组及ESBD组分别有36例(90%)及38例(95%)成功取净结石;机械碎石网篮应用比例分别37.5%(15/40)和10%(4/40),P<0.05;取石时间分别为41.78min±10.41min和36.28min±8.64min,P<0.05;术中EST组有2例出现切开后出血,ESBD组无出血病例;EST组各有1例出现发热和腹痛患者,有2例出现胰腺炎,ESBD组有2例腹痛,无发热患者,1例出现胰腺炎.术后早期并发症总发生率分别为10%(4/40)和7.5%(3/40),P>0.05;无死亡病例.结论:对较大胆总管结石,ESBD取石有与EST取石相近的成功率,术后并发症无明显升高,但在操作时间及碎石网篮使用上,ESBD组更有优势.

Endoscopic sphincterotomy plus balloon dilation for large bile duct stones:An analysis of 80 cases

AIM:To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy(EST)plus balloon dilation for large bile duct stones.METHODS:Eighty patients with bile duct stones larger than 1.2 cm,who received endoscopic retrograde eholangiopancreatography(ERCP)from January 2010 to October 2011 at our hospital,were randomly and equally divided into two groups to receive EST and EST plus balloon dilation(ESBD),respectively.Balloon dilation was conducted after small EST in the ESBD group,while conventional EST was used in the EST group.RESULTS:All stones were removed successfully from 36 patients(90%)of the EST groupand 38(95%)patients of the ESBD group.Mechanical lithotripsy was used to fragment stones in 15(37.5%)EST procedures and 4(10%)ESBD procedures.The operation time was longer in the EST group than in the ESBD group(41.78± 10.41 vs 36.28±8.64,P<0.05).Bleeding occurred in two patients of the EST group but not in patients of the ESBD group.Fever,abdominal pain,and acute pancreatitis developed in 1,1 and 2 patients in the EST group,while abdominal pain and acute pancreatitis in 2 and 1 patients in the ESBD group,respectively.There is no significant difference in the incidence of early complications between the two groups(10%vs 7.5%,P>0.05).No patient died.CONCLUSION:ESBD is superior to EST in terms of operating time and the use of mechanical litho-tripsy in managing large bile duct stones.