摘要
目的探讨内镜下单纯大柱状球囊扩张术治疗胆总管内大结石的安全性和有效性.方法对我院2016.01 ~2018.12期间采用内镜下单纯大柱状球囊扩张术(endoscopic papillary large balloon dilation,EPLBD)和内镜下乳头小切开+大柱状球囊扩张术(endoscopic minor sphincterotomy plus large balloon dilatation,EST+ EPLBD)进行治疗的胆总管内大结石患者的临床资料进行临床对照研究.结果 EPLBD组和EST+ EPLBD组总的结石清除率和一次结石清除率分别为100%(112/112);95.5%(107/112)和100%(87/87);96.6%(84/87),P均大于0.05,未见明显统计学差异.而前者机械碎石率和高淀粉酶血症发生率42.8%(48/112);33.0%(37/112)高于后者24.1%(21/87);19.5%(17/87),P<0.05,有统计学意义.两组术后急性胰腺炎(8/112,7.1%;6/87,6.8%)、消化道出血(2/112,1.8%;2/87,2.3%)和胆道感染(4/112,3.5%;3/87,3.4%)的并发症发生率未见明显统计学差异.两组均无穿孔和死亡病例.两组患者术后出现早期并发症的总例数分别为45.5%(51/112)和32.2%(28/87),P>0.05,无统计学差异.结论 EPLBD术治疗胆总管结石是安全可行的.但EPLBD术是否可以替代EST+ EPLBD术,尚需进一步的研究和探索.
Objective To investigate the efficiency and safety of endoscopic papillary large balloon dilation ( EPLBD) and endoscopic sphincterotomy plus large balloon dilatation ( EST + EPLBD) in treatment of with common bile(luct( CBD) stones. Methods Retrospectively analyzed the clinical data of patients with 10 ~ 20mm CBD stones who received EPLBD or EST + EPLBD from 2016. 01 to 2018. 12 in Anhui Provincial Hospital. Results There was no significant difference in the final success rates ( 112/112,100%;87/87,100%) and in the success rates in the first session( 107/112,95. 5%;84/87 ,96. 6%) between EPLBD and EST + EPBD. The use of mechanical lithotripsy was more frequent in the EPLBD (42. 8% vs. 24. 1%, P <0. 05). Asymptomatic hyperamylasemia occured morefrequently(33. 0% vs. 19. 5%, P <0. 05)after patients received EPLBD. There was no significant difference in acute pancreatiti( 8/112,7. 1%;6/87 ,6. 8%), bleeding in digestive tract (2/112,1. 8%;2/87,2. 3%) and infection of biliary tract (4/112, 3. 5%;3/87 ,3. 4%) between EPLBD and EST + EPBD. There were no cases of perforation or death in either group. The rates of shortterm complications were similar between the two groups( 51/112 ,45. 5%;28/87 ,32. 2%). Conclusion EPLBD and EST + EPLBD, the two operative methods with similar stone-free rate and the incidence rate of recent complications. EPLBD can be safely performed for large bile duct stones in choledocholithiasis patients. Are EPLBD can replace EST and EPLBD requires further research and exploration.
作者
魏亚军
王成
王刚
邵峰
胡元国
邱陆军
查恕云
WEI Ya-jun;WANG Cheng;WANG Gang(Anhui Medical University Affiliated Provincial Hospital,Hefei 230001, China)
出处
《肝胆外科杂志》
2019年第2期99-103,共5页
Journal of Hepatobiliary Surgery
基金
安徽省科技厅公益联动计划项目(1604f0804016)
