经内镜乳头括约肌切开术与经内镜乳头气囊扩张术治疗肝外胆管结石的临床比较

目的 比较经内镜乳头括约肌切开术（EST）与经内镜乳头气囊扩张术（EPBD）在治疗肝外胆管结石方面的异同。方法 回顾性分析第二军医大学长海医院消化内科2009年8月至2011年7月间277例肝外胆管结石住院患者的临床资料，其中行EST的168例，行EPBD的109例，分别对EST组和EPBD组病例的基本情况、结石直径、取石方法、手术时间、结石一次取净率、术后住院天数、近期并发症等进行比较。结果 两组病例在年龄、性别比、合并十二指肠憩室方面的差异均无统计学意义；EST组结石直径为（11.3±6.2）mm，EPBD组结石直径为（10.1±5.7）mm，两者差异无统计学意义（P=0.105 6）；EST组和EPBD组不同取石方法构成比，差异亦无统计学意义；EST组手术操作时间平均为（21.2±3.1）min，EPBD组为（20.7±2.5）min，两组间差异无统计学意义（P=0.159 1）；EST组结石一次取净率为95.2%，与EPBD组的94.5%比较，差异无统计学意义（P=0.782 8）；术后住院天数EST组为（4.1±1.9）d，EPBD组为（4.1±2.0）d，两者差异无统计学意义（P=1.000 0）；EST组近期并发症总发生率为10.1%，EPBD组为12.8%，差异无统计学意义（P=0.482 2）；EST组中出血的发生率为3.6%，EPBD组为0%，两组之间的差异具有统计学意义（P<0.05）；EPBD组高淀粉酶血症的发生率为8.3%，EST组为2.4%，差异具有统计学意义（P<0.05）。结论 EST和EPBD治疗肝外胆管结石各有利弊，对于手术方式的选择，应根据患者的具体情况，而无须局限于结石的大小。

Comparison of endoscopic sphincterotomy and endoscopic papillary balloon dilation in the treatment of extrahepatic bile duct stones

Objective To compare endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in treating extrahepatic bile duct stones in terms of similarities and differences. Methods The clinical data of 277 patients with extrahepatic bile duct stones, who were treated from August 2009 to July 2011 in gastroenterology department of Shanghai Changhai Hospital, were retrospectively analyzed, with 168 patients receiving EST and 109 receiving EPBD. The general condition, stone diameter, stone extraction method, operation time, stone-free rate by single procedure, postoperative hospital stay and short-term complications were compared between EST group and EPBD group. Results There were no significant differences in the age, sex ratio, or combination with duodenal diverticulum between the two groups.The mean diameters of the stones were not significantly different between the two groups (11.3±6.2] mm in EST group vs 10.1±5.7] mm in EPBD group, P=0.105 6). There was no significant difference in the proportions of different stone extraction methods between EST group and EPBD group. The operation time, stone-free rate by single procedure, postoperative hospital stay, and total incidence of short-term complications in EST group were (21.2±3.1)min, 95.2%, (4.1±1.9) d, and 10.1%, and those in EPBD group were (20.7±2.5) min, 94.5%, (4.1±2.0) d, and 12.8%, respectively; with no significant differences found between the two groups (all P>0.05). The incidence of hemorrhage in EST group was significantly higher than that in the EPBD group (3.6% vs 0%, P<0.05). The incidence of hyperamylasemia in EPBD group was significantly higher than that in the EST group (8.3% vs 2.4%, P<0.05). Conclusion EST and EPBD each have their own advantages and disadvantages in the treatment of extrahepatic bile duct stones. Operation mode should be chosen according to the specific condition of patients, but not the size of the stones.