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| 经内镜乳头括约肌切开术与经内镜乳头气囊扩张术治疗肝外胆管结石的临床比较 |
| 胡贯中,金震东,刘枫,张敏敏,王东,王洛伟,施新岗,陈洁,李兆申,邹多武 |
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| (复旦大学校医院内科;第二军医大学长海医院消化内科) |
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| 摘要: |
| ［摘要］ 目的 比较经内镜乳头括约肌切开术(EST)与经内镜乳头气囊扩张术(EPBD)在治疗肝外胆管结石方面的异同。方法 回顾性分析上海长海医院消化内科2009年8月至2011年7月277例肝外胆管结石患者的临床资料,其中行EST的168例，行EPBD的109例，分别对EST组和EPBD组的病例基本情况、结石直径、取石方法、手术时间、结石一次取净率、术后住院日、近期并发症等方面进行比较。结果 两组病例在年龄、男女性别比、合并十二指肠憩室方面的差异均无统计学意义；EST组结石直径为(11.3+6.2)mm，EPBD组结石直径为(10.1+5.7)mm，两者差异无统计学意义(P=0.1056)；EST组和EPBD组取石方法之间比较，差异无统计学意义；EST组手术操作时间平均为(21.2+3.1)min，EPBD组手术操作时间平均为(20.7+2.5)min，两者差异无统计学意义(P=0.1591)；EST组结石一次取净率为95.2%，与EPBD组的94.5%比较，两者差异无统计学意义（P=0.7828）；术后住院日EST组为（4.1+1.9）d；EPBD组为（4.1+2.0）d，两者差异无统计学意义(P=1.0000)；EST组近期并发症总发生率为10.1%，EPBD组为12.8%，两者差异无统计学意义(P=0.4822)，EST组中出血的发生率为3.6%，EPBD组为0，两者之间的差异具有统计学意义(P<0.05)；EPBD组的高淀粉酶血症的发生率为8.3%，EST组为2.4%，两者之间的差异具有统计学意义(P<0.05)。结论 EST和EPBD治疗肝外胆管结石各有利弊，对于手术方式的选择，应根据患者的具体情况而无须局限于结石的大小。 |
| 关键词: 胰胆管造影术，内窥镜逆行 括约肌切开术，内窥镜 气囊扩张术 胆总管结石 |
| DOI：10.3724/SP.J.1008.2014.00860 |
| 投稿时间：2012-10-31修订日期：2013-07-19 |
| 基金项目: |
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| Comparison of endoscopic sphincterotomy and endoscopic papillary balloon dilation in the treatment of extrahepatic bile duct stones |
| HU Guan-zhong,JIN Zhen-dong,LIU Feng,ZHANG Min-min,WANG Dong,WANG Luo-wei,SHI Xin-gang,CHEN Jie,LI Zhao-shen,ZOU Duo-wu |
| (Department of Gastroenterology，Changhai Hospital，Second Military Medical University，Shanghai 200433，China) |
| Abstract: |
| ［Abstract］ Objective To compare endoscopic sphincterotomy ( EST ) and endoscopic papillary balloon dilation ( EPBD ) in the treatment of extrahepatic bile duct stones in terms of similarities and differences. Methods Clinical data of 277 patients with extrahepatic bile duct stones from August 2009 to July 2011 in gastroenterology department of Shanghai Changhai Hospital were retrospectively analyzed. 168 of the 277 patients received EST and the other 109 received EPBD.The general case, stone diameter, stone extraction method, operation time, stone once complete clearance rate, postoperative hospital stay and short-term complications of EST group and EPBD group were compared. Results There was no statistic difference in the age, sex ratio, combined duodenal diverticulum between two groups .The stone diameter was (11.3+6.2 ) mm in EST group and that was (10.1+5.7 ) mm in EPBD group. There was no statistic difference between them( P=0.1056 ). There was no statistic difference in the stone extraction method between EST group and EPBD group. The operation time was (21.2+3.1)min in EST group and that was (20.7+2.5) min in EPBD group. There was no statistic difference between them(P=0.1591). The stone once complete clearance rate was 95.2% in EST group and that was 94.5% in EPBD group. There was no statistic difference between them( P=0.7828 ).The postoperative hospital stay was ( 4.1+1.9 ) day in EST group and that was ( 4.1+2.0 ) day in EPBD group. There was no statistic difference between them( P=1.0000 ).The incidence of short-term complications was 10.1% in EST group and that was 12.8% in EPBD group. There was no statistic difference between them( P=0.4822 ).The incidence of hemorrhage was 3.6% in EST group and that was 0 in EPBD group. There was statistic difference between them( P<0.05 ). The incidence of hyperamylasemia was 8.3% in EPBD group and that was 2.4% in EST group. There was statistic difference between them( P<0.05 ). Conclusion EST and EPBD each have advantages and disadvantages in the treatment of extrahepatic bile duct stones . Suitable operation mode should be chosen by the specific situation of patients and not limited to the size of the stones. |
| Key words: Cholangiopancreatography,Endoscopic Retrograde Sphincterotomy, Endoscopic Balloon Dilation Choledocholithiasis |
