经内镜乳头括约肌小切开联合球囊扩张术治疗老年胆总管结石患者的疗效与安全性分析

目的 探讨经乳头括约肌小切开联合球囊扩张术治疗老年胆总管结石的疗效与安全性.方法 回顾性分析2018年1月—2019年1月因胆总管结石在郑州大学第一附属医院行内镜逆行胰胆管造影术(ERCP)治疗的≥60岁患者资料240例.按不同手术方式分为EST组和改良sEST+EPBD组.比较两组患者一般资料、取石情况、不同时间点血...

Efficacy and safety analysis of small endoscopic sphincterotomycombined with endoscopic papillary balloon dilation in thetreatment of choledocholithiasis in the elderly*

Objective To investigate the efficacy and safety of small endoscopic sphincterotomy combinedwith endoscopic papillary balloon dilation (sEST+EPBD) in the treatment of choledocholithiasis in the elderly.Methods We retrospectively analyzed the data of 240 patients over 60 years old who underwent endoscopicretrograde cholangiopancreatography (ERCP) treatment in our hospital from January 2018 to January 2019 due tocholedocholithiasis. According to different surgical methods, the patients were divided into traditional endoscopicsphincterotomy (EST) group and modified sEST+EPBD group. The general information, stone removal, bloodamylase before and after surgery, and postoperative complications were compared between the two groups.Results A total of 83 patients in sEST+EPBD group and 147 patients in EST group underwent successfulselective bile duct cannulation and ERCP procedure, and the success rate was 95.83% (230/240). The placement ofbiliary plastic stent was performed in 12 patients in EST group and 25 patients in sEST+EPBD group due to oversize and overmuch stones which contributed to difficulties in one-off removal. In the cases of stone removal,the operation time in the sEST+EPBD group was shorter than that in the EST group, and the rates of mechanicallithotripsy and intraoperative bleeding in the sEST+EPBD group were lower than those in the EST group (P <0.05). The blood amylase at 6 hours after surgery was higher in the sEST+EPBD group than that in the EST group(P < 0.05), while the blood amylase at 24 hours after surgery was lower in the sEST+EPBD group than that in theEST group (P < 0.05). As for the postoperative complications, the overall complication rate of sEST+EPBD groupwas lower than that of EST group (P < 0.05). Conclusions For elderly patients with choledocholithiasis, sESTcombined with EPBD can better shorten the operation time, reduce the rates of mechanical lithotripsy andintraoperative bleeding, and decrease the overall complication rate. Generally, sEST combined with EPBD is safeand effective, which is of value for further clinical application.