内镜下乳头括约肌小切开术联合球囊扩张术治疗胆总管结石的临床价值

目的探讨采用内镜下乳头括约肌小切开术联合球囊扩张术(sEST+EPBD)治疗胆总管结石的临床疗效及可能存在的机制。方法选取2013年1月-2017年12月因胆总管结石入住该院的200例患者,分为单纯内镜下乳头括约肌切开术(EST)组和sEST+EPBD组,每组100例。对两组患者的手术时间、住院时间、总费用、并发症以及炎症指标进行比较分析。结果两组患者术后均未发生胰腺炎,所有患者均治愈。其中,sEST+EPBD组患者平均手术时间、住院时间、出血量及术后胆道感染均明显少于EST组(P<0.05)。两组患者总费用和胆道穿孔比较,差异无统计学意义(P>0.05)。术后1及24 h,sEST+EPBD组白细胞(WBC)、环氧化酶-2(Cox-2)、降钙素原(PCT)、C反应蛋白(CRP)以及肿瘤坏死因子(TNF-α)水平均明显低于EST组(P<0.01),而sEST+EPBD组的血淀粉酶水平明显升高(P<0.01);术后72 h,sEST+EPBD组WBC及Cox-2水平均明显低于EST组(P<0.05),PCT、CRP、淀粉酶以及TNF-α水平则差异无统计学意义(P>0.05)。结论sEST+EPBD是治疗胆总管结石的一种有效、安全的方法,能减少手术时间、住院时间,有效控制术后胆道感染的发生,并且能明显降低炎症反应。

Clinical value and mechanism of small endoscopic sphincterotomy +endoscopic papillary balloon dilation in treatment of choledocholithiasis

Objective To investigate the clinical role and possible mechanism of small endoscopic sphincterotomy combined with endoscopic papillary balloon dilation(sEST+EPBD)in treatment of choledocholithiasis.Methods 200 patients with choledocholithiasis from January,2013 to December,2017 were divided into the EST group and the sEST+EPBD group.The operative time,hospitalization time,total cost,complications and inflammatory indexes of the two groups were compared and analyzed.Results No pancreatitis occurred in the two groups after operation and all the patients were cured.In addition,mean operation time,hospitalization time,blood loss and postoperative biliary tract infection in the sEST+EPBD group were significantly lower than those in the EST group(P<0.05).There was no significant difference in average total cost and biliary tract perforation between the two groups(P>0.05).At 1 h and 24 h after the operation,WBC,Cox-2,PCT,CRP and TNF-αlevels in the sEST+EPBD group were significantly lower than those in the EST group(P<0.01),while the serum amylase level in the sEST+EPBD group was significantly higher(P<0.01).At 72 h after surgery,levels of WBC and Cox-2 in the sEST+EPBD group were significantly lower than those in the EST group(P<0.05),while levels of PCT,CRP,amylase and TNF-αwere insignificant(P>0.05).Conclusion Small endoscopic sphincterotomy+endoscopic papillary balloon dilation is an effective and safe method for the treatment of choledocholithiasis,which can reduce the duration of surgery and hospitalization,effectively control the occurrence and postoperative biliary tract infection,and significantly reduce the inflammatory response.