内镜下乳头括约肌小切开术联合球囊扩张术治疗非扩张性肝外胆管结石患者疗效再研究

目的 分析采取内镜下乳头括约肌小切开术(EST)联合球囊扩张术(EPBD)治疗非扩张性肝外胆管结石患者的疗效及其血清淀粉酶(AMS)和环氧合酶-2(COX-2)水平的变化。方法 2017年7月～2019年5月我院肝胆外科收治的120例非扩张性肝外胆管结石患者,其中60例接受EST治疗,另60例接受EST联合EPBD治疗。结果 在术后7 d,联合组外周血白细胞(WBC)计数为(7.8±1.4)×10⁹/L,与对照组的(7.6±1.2)×10⁹/L比,差异无统计学意义(P>0.05),血清COX-2水平为(45.3±11.7)ng/mL,与对照组的(49.6±15.2)ng/mL比,差异无统计学意义(P>0.05),血降钙素原(PCT)水平为(0.4±0.3)μg/L,与对照组的(0.4±0.2)μg/L比,差异无统计学意义(P>0.05),C反应蛋白(CRP)水平为(8.7±2.9)mg/L,与对照组的(8.4±3.2)mg/L比,差异无统计学意义(P>0.05),肿瘤坏死因子-α(TNF-α)水平为(0.5±0.2)ng/mL,与对照组的(0.5±0.2)ng/mL比,差异无统计学意义(P>0.05),血清AMS水平为(60.1±16.7)U/L,与对照组的(58.7±15.3)U/L比,差异无统计学意义(P>0.05);术后,联合组并发症发生率为25.0%,与对照组的31.7%比,差异无统计学意义(P>0.05);联合组一次取石成功率为98.3%,显著高于对照组的86.7%,机械碎石率为5.0%和结石复发率为3.3%, 则均显著低于对照组(分别为16.7%和15.0%,P<0.05)。结论 EST联合EPBD治疗非扩张性肝外胆管结石患者能一次取净结石,而在EPBD的协助下不会加剧机体炎症反应,降低术后结石复发,值得临床进一步研究。

Combination ofendoscopic sphincterotomy and endoscopic papillary balloon dilation intreatment of patients with non-expansive extrahepatic bile duct stones

Objective The purpose of this study was to investigate the combination of endoscopic sphincterotomy(EST)and endoscopic papillary balloon dilation(EPBD)in treatment of patients with non-expansive extrahepatic bile duct stones.Methods The clinical data of 120 patients with non-expansive extrahepatic bile duct stones were admitted to the Department of Hepatobiliary Surgery in our hospital between July 2017 and May 2019,and were randomly divided into control(n=60)and observation group(n=60),underwent EST or EST and EPBD combination surgery.Results 7 days after the operation,the white blood cell(WBC)counts in the observation group was(7.8±1.4)×10^9/L,not statistically significantly different as compared to(7.6±1.2)×10^9/L in the control(P>0.05),serum cyclooxygenase-2 level in the observation group was(45.3±11.7)ng/mL,not much different to(49.6±15.2)ng/mL,blood procalcitonin(PCT)level was(0.4±0.3)g/L,not significantly different to(0.4±0.2)g/L,serum C-reactive protein(CRP)level was(8.7±2.9)mg/L,not significantly different to(8.4±3.2)mg/L,serum tumor necrosis factor-α(TNF-α)level was(0.5±0.2)ng/mL,not significantly different to(0.5±0.2)ng/mL,blood amylase level was(60.1±16.7)U/L,not significantly different to(58.7±15.3)U/L in the control(P>0.05);the total incidence of complications in the observation group was 25.0%,not statistically significantly different compared with 31.7%(P>0.05)in the control;the successful rate of primary stone removal in the observation group was 98.3%,significantly higher than 86.7%in the control,and the mechanical gravel rate was 5.0%and the stone recurrence rate was 3.3%,both significantly lower than 16.7%and 15.0%,respectively,(P<0.05)in the EST-treated patients.Conclusion The combination of EST and EPBD in the treatment of patients with non-dilated extrahepatic bile duct stones has a higher successful rate of one-step stone extraction,with less postoperative stone recurrence,which warrants further clinical investigation.