【摘要】 目的研究胆总管结石内镜乳头括约肌切开术(EST)中不同种类的切割电流对EST并发症的影响,为临床合理选择EST电流提供依据。方法365例行EST的胆总管结石患者随机施行单纯电流切割(PC组,n=122)、混合电流切割(BC组,n=122)、先行PC后行BC的联合电流切割(CC组,n=121)。检测三组患者EST术前、术后4h及24h血清淀粉酶,并观察术中出血及术后胰腺炎的发生率。结果三组患者EST术前血清淀粉酶水平无显著差异(P>0.05);EST术后4h及24h血清淀粉酶水平BC组明显高于PC组、CC组(P<0.05),高淀粉酶血症发生率BC组也明显高于PC组、CC组(P<0.05),而PC组与CC组相比EST术后血清淀粉酶水平及高淀粉酶血症发生率均无统计学意义(P>0.05);EST术后胰腺炎发生率BC组(12.3%)明显高于PC组(4.9%)、CC组(5.8%)(P<0.01),而PC组与CC组无显著差异(P>0.05)。术中出血发生率PC组(25.4%)明显高于BC组(11.4%)、CC组(13.2%)(P<0.05),而BC组与CC组相比无统计学意义(P>0.05)。结论使用联合切割电流既可减少EST病人术中出血的发生,也能减轻术后高淀粉酶血症及减少胰腺炎的发生。更多还原

【Abstract】 Objective To study the influence of various electrosurgical current on complications in endo-scopic sphincterotomy for patients with choledocholithiasis and to provide evidence for selecting electrosurgicalcurrent. Methods Three hundred and sixty-five patients with choledocholithiais were randomly underwentendoscopic sphincterotomy with pure cutting current(n=122, Group PC) ,blended current (n=122, GroupBC) ,or pure cutting initially followed blended current (n=121, Group CC),respectively. Serum concentra-tions of amylase were detected in all patients before sphincterotomy and 4,24 hours after sphincterotomy. Theincidences of bleeding during sphincterotomy and postsphincterotomy pancreatitis were observed in each group. Results There were no significant differences among three groups with serum concentrations of amylase be-fore sphincterotomy (P>0.05). Serum concentrations of amylase were higher at4 and 24 hours after procedurein group BC compared with those of group PC or group CC (P<0.05). The incidence of hyperamylasemia washigher in group BC (P<0.05). Serum concentrations of amylase after sphincterotomy and incidence of hy-peramylasemia were no significant differences between group PC and group CC (P>0.05). The incidence ofpostsphincterotomy pancreatitis was higher in group BC compared with that of group PC or group CC (P<0.05). The incidence of bleeding during sphincterotomy was higher in group PC compared with that of groupBC or group CC (P<0.05), however, there were no significant differences between group BC and group CC(P>0.05). Conclusion Combo cut (pure cutting initially followed blended current) not only decreasethe incidence of bleeding during sphincterotomy but also lessen the incidences of postsphincterotomy hyperamy-lasemia and pancreatitis.更多还原