胆总管结石内镜逆行胰胆管造影术后行胆道支架置入和鼻胆管引流并发症的比较

目的探讨胆总管结石患者采用内镜逆行胰胆管造影术（ERCP）取石后同期开展胆道支架置入术或开展经内镜鼻胆管引流术（ENBD）,对于防范并发症的价值。 方法按照前瞻性研究原则,选择2017年4月至2019年1月新疆医科大学第一附属医院收治的338例胆总管结石患者,随机分为支架组（170例）与引流组（168例）。两组患者均行ERCP治疗,其中引流组术后同期开展ENBD,支架组患者术后开展胆道支架置入术,对比两组患者腹痛评分、并发症发生情况及预后。 结果两组患者术后均未合并严重出血、穿孔或病死,结石完全清除率差异无统计学意义。与支架组相比,引流组术中胰腺管插管次数,术后4 h血淀粉酶水平、高淀粉酶血症、急性胰腺炎以及并发症总发生率更高,差异有统计学意义（P<0.05）,术后24、48、72 h不同时点腹痛测评分值居更高水平（P<0.05）。 结论对于胆总管结石行ERCP治疗的患者,术后予以ENBD、胆道支架置入术的结石完全清除效果对比无明显差异,但胆道支架置入术更能降低术后并发症风险、缓解腹痛症状,患者获益更多。

Comparison of complications between biliary stent implantation and nasobiliary drainage after endoscopic retrograde cholangiopancreatography for choledocholithiasis

ObjectiveTo investigate the value of biliary stent implantation or endoscopic nasobiliary drainage after endoscopic retrograde cholangiopancreatography (ERCP) in preventing complications in patients with choledocholithiasis. MethodsIn this prospective study, 338 patients with choledocholithiasis admitted to the First Affiliated Hospital of Xinjiang Medical University from April 2017 to January 2019 were randomly divided into stent group (170 cases) and drainage group (168 cases). All patients were treated with ERCP. Nasal bile duct drainage was performed concurrently in the drainage group; biliary stent implantation was performed in the stent group. The incidence of complications and prognosis were compared between the two groups. ResultsNo severe bleeding, perforation or death occurred in the two groups, and there was no significant difference in the complete stone clearance rate between the two groups. Compared with the stent group, the drainage group had higher incidence of pancreatic tube intubation, blood amylase level 4 h after operation, hyperamylasemia, acute pancreatitis and the total incidence of complications (P<0.05). The abdominal pain scores at different time points 24, 48 and 72 h after operation were higher (P<0.05) in the drainage group. ConclusionsFor patients with choledocholithiasis treated with ERCP, ENBD and biliary stent implantation show no significant difference in the effect of complete stone removal, but biliary stent implantation can reduce the risk of postoperative complications, relieve abdominal pain symptoms, and maximize the patients’ benefit.