乳头括约肌小切开联合柱状球囊扩张术治疗巨大型胆总管结石的临床研究

目的  探讨乳头括约肌小切开联合柱状球囊扩张术治疗巨大型胆总管结石的效果和安全性。 方法  选取2012年1月-2015年12月于山东省东营市胜利油田中心医院收治的167例最大直径≥15 mm的胆总管结石患者，按照随机数表法分为EST组和sEST+EPBD组，比较两组取石成功率、术中X线透射时间、术后近、远期并发症，采用Logstic回归分析影响取石成功率和术后胰腺炎发生率的相关因素。结果  EST组和sEST+EPBD组取石成功率分别为91.5%和92.7%（P =0.076）；EST组X线透射时间长于sEST+EPBD组（P < 0.01）；术后两组近期并发症发生率分别16.9%和10.4%（P =0.221），EST组术后乳头出血发生率高于sEST+EPBD组（P =0.018）；EST和sEST+EPBD两组术后远期并发症分别出现12例（16.9%）和6例（6.25%），差异有统计学意义（P =0.028），两组术后急性胆管炎分别出现5例和1例（P =0.039）；Logstic回归分析提示，胆总管结石大小是影响取石成功率、内镜后胰腺炎发生的因素。结论  EST和sEST+EPBD方法治疗巨大型胆总管结石的取石成功率较高，两组术中X暴露时间、术后近远期并发症发生率有差异，应该权衡利弊综合考虑选择手术方案。

Clinical study of small endoscopic sphincterotomy combined with endoscopic balloon dilatationfor large common bile duct stones

Objective To explore the safety and efficacy of small endoscopic sphincterotomy combined with endoscopic balloon dilatation (sEST+EPBD) for large common bile duct stones. Methods From Jan. 2012 to Dec. 2015, 167 patients suffered from large common bile duct stones were recruited to Central Hospital of Shengli Oil Field and randomly divided into EST group (n = 71) and sEST+EPBD group (n = 96). The safety and efficacy of EST and sEST + EPLBD were compared by logstic regression analysis. Results The complete stone removal ratesin of EST and sEST+EPBD were 91.5% and 92.7%, respectively (P = 0.076), and the X-ray exposure time was significantly shorter in sEST+EPBD group (P <0.001). There was no significant difference in the incidence rate of recent complications between EST and sEST+EPBD groups (P = 0.221), however, the incidence of bleeding and long-term complications in the sEST+EPBD group was significantly lower (P = 0.018, 0.028, accordingly). Bile duct stone diameter was a factor influenced both successful stone removal and post-ERCP pancreatitis. Conclusions Both EST and sEST+EPBD are approximately equivalent in terms of successful clearance of large common bile duct stones, the complications in two groups are different. Therefore, it is necessary to select the optimal surgical project according to the actual clinical situation.