乳头括约肌小切开联合球囊扩张术治疗十二指肠乳头旁憩室合并胆总管结石41例疗效观察

目的 探究乳头括约肌小切开（SEST）联合球囊扩张术（EPBD）治疗十二指肠乳头旁憩室（JPDD）合并胆总管结石患者的临床效果。方法 2014年11月～2016年10月我院诊治的82例JPDD合并胆总管结石患者，采用随机数字表法分为SEST联合EPBD组41例和EST组41例，分别行EST术或SEST联合EPBD术。结果 SEST联合EPBD组一次取石成功率（90.24%）和总取石成功率（95.12%）显著高于EST组（分别为73.17%和78.05%），而机械碎石率（12.20%）显著低于EST组（31.71%），差异有统计学意义（P＜0.05）；SEST联合EPBD组住院时间为（7.98±1.14） d，显著短于EST组的（11.03±1.39） d，差异有统计学意义（P＜0.05），SEST联合EPBD组住院费用为（15411.26±113.20）元，与EST组（15381.57±121.43）元比，差异无统计学意义（P＞0.05）；术前两组TBIl水平比较差异无统计学意义（P＞0.05），术后两组TBIl水平均较术前降低，组间比较差异无统计学意义（P＞0.05）；SEST联合EPBD组并发症发生率（9.76%）低于EST组（36.59%），差异有统计学意义（P＜0.05）。结论 联合采用乳头括约肌小切开和球囊扩张术治疗十二指肠乳头旁憩室合并胆总管结石效果显著，可提高取石成功率，减少住院时间，降低机械碎石率及并发症发生率，值得验证。

Efficacy of small incision of sphincterotomy and balloon dilatation in treatment of patients with juxtapapillary duodenal diverticulum and common bile duct stones

Objective To investigate the efficacy of small incision of endoscopic sphincterotomy （SEST） and endoscopic papillary balloon dilatatio （EPBD） in treatment of patients with juxtapapillary duodenal diverticulum（JPDD） and common bile duct stones. Methods 82 patients with choledocholithiasis of JPDD were divided into study group and control group， with 41 cases in each group. The patients in the control group were treated with EST and in the study group were treated with SEST and EPBD. Results The one time success rate （90.24%） and the total success rate（95.12%） in the study group were higher than those in the control group （73.17% and 78.05%，respectively），and the mechanical lithotripsy rate was 12.20%，much lower than 31.71% in the control group （P<0.05）；the hospitalization stay in the study group was （7.98±1.14） days，much shorter than （11.03±1.39） days in the control group（P<0.05）；serum bilirubin levels in the two groups before and after operation had no significant difference （P>0.05）；The incidence rates of complications（9.76%） in the study group was lower than （36.59%） in the control group（P<0.05）. Conclusion Small endoscopic sphincterotomy and balloon dilation in the treatment of patients with juxtapapillary duodenal diverticulum accompanied by common bile duct stones has a good efficacy，with higher success rate of stone removal， shorter hospitalization stay，and lower incidence rate of complications.