十二指肠镜2种方法治疗胆管结石的比较

目的比较分析内镜下十二指肠乳头括约肌切开术（EST）和十二指肠乳头球囊扩张术（EPBD）治疗胆总管结石的临床疗效。方法选取河池市人民医院及右江民族医学院附属医院2010年3月2011年10月住院治疗的60例胆管结石患者，其中38例进行EST治疗，22例进行EPBD治疗．比较两组的疗效及并发症的发生率。结果EST组术后结石取净率为94．74％，EPBD组为95．45％．两者比较差异无统计学意义（x2=0．015，P〉0．05）；EST组近期并发症的发生率为5．56％明显低于EPBD组的23．80％（X2=4．102，P〈0．05）；EPBD组胰腺炎的发生率为19．04％明显高于EST组的2．78％（X2=4．387,P〈0．05）。EST组远期并发症的发生率为19．4％，而EPBD组未出现远期并发症，二者有显著性差异（x2=4．655，P〈0．05）。结论EST术和EPBD术治疗胆总管结石的结石清除率接近，但EST的并发症特别是术后胰腺炎的发生率较低，而EPBD的远期并发症较低，说明两种方法各有利弊，但均安全有效，临床应根据患者结石数目和结石大小选择适合的手术方式。

Duodenoscopy treating bile duct stone:comparison of two methods

Objective To compare the clinical efficacy of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) for treating bile duct stones. Methods Sixty patients with bile duct stones in our hospital were divided into EST group and EPBD group. Thirty-eight patients were in EST group, while 22 patients were in EPBD group. The treatment outcomes and the incidence of complications were compared between the two groups. Results Successful clearance of bile duct stones was 94.74% in EST group, and 95.45% in EPBD group (χ2 = 0.015, P > 0.05), The short-term incidence of complications in EST group was 5.56% which was lower than 23.80% in EPBD group (χ2 = 4.102, P < 0.05). The incidence of pancreatitis in EPBD group was 19.04%, which was significantly higher than 2.78% in EST group (χ2 = 4.387, P < 0.05). Long-term complication rate in EST group was 19.4%, while no long-term complications were fount in EPBD group (χ2 = 4.655, P < 0.05). Conclusion The clearance rate of EST and EPBD for treating bile duct stones is compatible. However, the complications (especially the incidence of postoperative pancreatitis) in EST group are lower than that in EPBD group, and EPBD group has lower long-term complications than EST group.