摘要
目的：探讨内镜下乳头括约肌小切开联合球囊扩张术（sEST＋EPBD）治疗合并十二指肠乳头旁憩室（JPDD）的胆总管结石患者的疗效。方法纳入2011年1月至2015年1月行内镜逆行胰胆管造影术（ERCP）的149例合并 JPDD 的胆总管结石患者，其中 sEST＋EPBD 组60例，EST 组89例。比较两组的 ERCP 成功率和一次性取石成功率，血清 TBil 和 DBil 水平的变化，以及术后并发症的发生率。统计学分析采用卡方检验或 t 检验。结果 sEST＋EPBD 组的 ERCP 成功率为100.0%（60／60），一次性取石成功率为91.7%（55／60）；EST 组的 ERCP 成功率为98.9%（88／89），一次性取石成功率为77.5%（69／89）；两组 ERCP 成功率差异无统计学意义（χ2＝0.19，P ＝0.410）；前者的一次性取石成功率高于后者，差异有统计学意义（χ2＝5.53，P ＝0.020）。sEST＋EPBD 组术后血清 TBil 为（152.62±109.04）μmol／L，低于术前的（266.02±143.31）μmol／L，差异有统计学意义（t ＝4.88，P ＜0.01）；sEST＋EPBD组术后血清 DBil 为（87.13±65.90）μmol／L，低于术前的（175.70±100.53）μmol／L，差异有统计学意义（t＝5.71，P＜0.01）。EST 组术后血清 TBil 为（251.90±247.90）μmol／L，低于术前的（340.20±176.20）μmol／L，差异有统计学意义（t＝2.74，P ＜0.05）；EST 组术后血清 DBil 为（168.10±140.60）μmol／L，低于术前的（228.40±139.60）μmol／L，差异有统计学意义（t＝2.87，P ＝0.005）。sEST＋EPBD 组术后并发症发生率为8.3%（5／60），低于 EST 组的20.2%（18／89），差异有统计学意义（χ2＝3.88，P ＝0.049）。结论sEST＋EPBD治疗合并 JPDD 的胆总管结石，可提高一次性取石成功率，是一种安全、有效的治疗方法。
Objective To explore the efficacy of endoscopic sphincterotomy with small incision combined with balloon dilatation （sEST＋EPBD）in the treatment of patients with choledocholithiasis and juxtapapillary duodenal diverticula （JPDD）.Methods From January 2011 to January 2015 ,149 patients with choledocholithiasis and JPDD who underwent endoscopic retrograde cholangio-pancreatography （ERCP）were enrolled.Among them,60 patients were in sEST＋EPBD group and 89 were in endoscopic sphincterotomy （EST）group.Success rate of ERCP and first-time stone removal,changes of total bilirubin （TBil）and direct bilirubin （DBil）levels,as well as the incidence of postoperative complications between the two groups were compared.Chi-square test or t-test was performed for statistical analysis. Results The ERCP success rate sEST＋EPBD group was 100.0% （60/60）,and the first-time success rate of stone removal was 91 .7%（55/60）;correspondingly,ERCP success rate of EST group was 98.9%（88/89）,and the success rate of first-time stone removal was 77.5 %（69/89）.There was no statistically significant difference in success rate of ERCP between the two groups （χ2 =0.19,P =0.410）.The first-time success rate of stone removal of sEST ＋EPBD group was higher than that of EST group,and the difference was statistically significant （χ2 =5 .53,P =0.020）.After operation,the TBil level of sEST＋ 〈br〉 EPBD group was （152.62 ±109.04 ）μmol/L,which was lower than that before operation （（266.02 ± 143.31）μmol/L）,and the difference was statistically significant （t =4.88,P 〈0.01 ）.After operation, the DBil level of sEST ＋EPBD group was （87.13 ±65 .90）μmol/L,which was lower than that before operation （（175 .70 ± 100.53 ）μmol/L）,and the difference was statistically significant （t = 5 .71 ,P 〈0.01）.After operation,the TBil level of EST group was （251 .90 ±247.90）μmol/L,which was lower than that before operation （（340.20 ±176.20 ）μmol/L）,and the differenc
出处
《中华消化杂志》
CAS
CSCD
北大核心
2016年第6期383-387,共5页
Chinese Journal of Digestion
