内镜下括约肌小切开联合气囊扩张术治疗胆总管结石比较分析

目的 比较内镜下括约肌切开术（EST）和内镜下括约肌小切开联合气囊扩张术（sEST＋ EPBD）治疗胆总管结石的效果及并发症.方法 回顾性分析2009年以来采用EST、sEST＋EPBD两种方法治疗的胆总管结石患者的临床效果及并发症.全组共计272例,151（2009年1月至2010年12月）例行内镜下乳头括约肌切开术（EST）,121（2011年1月至2013年12月）例行内镜下乳头括约肌小切开联合气囊扩张术（EST、sEST＋ EPBD）,均根据实际情况在乳头治疗后行取石篮取石和（或）气囊取石,部分患者以碎石篮碎石后取石.采用SPSS16.0软件分析,对计量资料t检验,计数资料x2检验,P＜0.05表示具有统计学意义.结果 所有患者采用主动取石,均全部一次性取尽结石,无自然排石.两种方法取石效果相同,sEST＋ EPBD组术后并发症的发生率显著降低,出血发生减少,明显降低了术后高淀粉酶血症的发生率.术后并发症发生率：EST组7.94％（12/151）,sEST＋EPBD组2.47％（3/121）,EST组明显高于sEST＋ EPBD组,差异具有统计学意义（x2=3.854,P＜0.05）.结论 应用乳头括约肌小切开联合气囊扩张术治疗胆总管结石,术后并发症减少,在胆总管结石的治疗中更为有效、安全.

Clinical analysis of small endoscopic sphincterotomy combined with endoscopic balboon dilatation in the treatment of common bite duct stones

Objective To compare the clinical efficacy and complications of endoscopic sphincterotomy （EST） and small endoscopic sphincterotomy combined with endoscopic balloon dilalalion （sEST ＋ EPBD） in the treatment of common bite duct stones.Methods Clinical data of 272 patients with common bite duct stones in both groups were analyzed retrospectively,including 151 patients who underwent EST from Jan 2009 to Dec 2013,and 121 patients who underwent sEST ＋ EPBD （by stone basket or balloon） from Jan 201 1 to Dec 2013.In some patients the stones were crushed by mechanical cithocripsy.Student＇s t test and the chi-test were used for statistical analysis.P ＜ 0.05 was considered statistically siginificant.Results All of the patients with common duct stones underwent active and complete removal of stones,with no obvious difference between the two groups.Compared with the EST group,the rates of complication,hemorrhage and hyper-angtasemia were significantly decreased in the sEST ＋ EPBD group （P ＜ 0.05）.The rate of complications was 2.47％ （3/121） in the sEST ＋ EPBD group,whereas 7.94％ （12/151） in the EST group （x2 =3.854,P ＜ 0.05）.Conclusions Small endoscopic sphinctotomy combined with endoscopic balloon dilatation in treating patients with common duct stones is effectivc and safe with less complications.