经内镜乳头小切开联合气囊扩张治疗胆总管结石的疗效及安全性分析

目的 观察经内镜十二指肠乳头小切开联合气囊扩张治疗胆总管结石的有效性、安全性,探讨如何减少近期、远期并发症的发生.方法 将本院确诊的胆总管结石患者120例,按随机数字表法分为三组,分别采用经内镜十二指肠乳头小切开联合气囊扩张术（A组）40例、经内镜十二指肠乳头切开术（EST）B组]40例、经内镜乳头扩约肌气囊扩张术（EPBD）C组]40例,观察三组的手术疗效及术后近期远期并发症的发生率.结果 （1）三组患者总取石率无差异;A组与B组一次取石率差异无统计学意义（P＞0.05）,但均高于C组（P＜0.05）;而C组碎石率高于A组及B组（P＜0.05）.（2）A组和C组术后出血的发生率低于B组,A组和B组术后胰腺炎的发生率低于C组.（3）在远期并发症中,A组未发生反流性胆管炎和结石复发,A组术后结石复发率低于B组及C组（P＜0.05）,A组和C组胆道积气征发生率明显低于B组.结论 经内镜十二指肠乳头小切开联合气囊扩张在治疗胆总管结石的疗效方面与EST相当,优于EPBD组,其术后近期及远期并发症发生率低于EST组及EPBD组.

Efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in treatment of common bile duct calculi

Objective To explore the therapeutic efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi in order to reduce the recent and long-term complications.Methods A total of 120 cases of patients with common bile duct calculi was grouped into three groups：endoscopic sphincterotomy joint balloon dilatation,endoscopic sphincterotomy （EST）,and endoscopic papillo-sphincter balloon dilatation （EPBD）.The operative efficacy of three groupsand the incidence of postoperative immediate and long-term complications were observed and compared.Results No difference was found in total stone-free rate among three groups.No significant difference was found in a stone-free rate and lithotripsy rate between endoscopic sphincterotomy joint balloon dilatation and EST groups （P 〉 0.05）,however,those parameters in the former two groups were better than EPBD group （P 〈 0.05）.The incidence of postoperative bleeding in the endoscopic sphincterotomy joint balloon dilatation group is lower than EST group.The incidence of postoperative pancreatitis in the endoscopic sphincterotomy joint balloon dilatation and EST groups was lower than the EPBD group（P 〈 0.05）.For the long-term complications,the incidence of reflux cholangitis in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST group （P 〈 0.05）.The recurrence rate of postoperative bile duct calculi in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST and EPBD groups.Conclusions For the endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi,its curative effect was the same as the EST,but better than EPBD; it had a lower incidence of immediate and long-term complications than EST and EPBD.