【摘要】 目的:探讨经内镜下十二指肠乳头小切开术(SES)联合乳头球囊扩张术(EPBD)治疗直径大于1 cm胆总管结石的临床价值。方法:随机抽取2011-2018年行ERCP治疗的胆管结石病例,根据治疗方法的不同分为SES联合EPBD组、经内镜下十二指肠乳头切开术(EST)大切开组、EPBD组,每组分别随机抽取30例,统计病人术后1周胰腺炎、上消化道出血并发症发生率,术后12个月胆总管结石复发率、手术操作时间、术中碎石器使用率等。结果:90例结石直径>1 cm的病人取石均成功。术中、术后均无消化道穿孔及胆管炎的发生。3组术后1周内并发上消化道出血率比较:SES联合EPBD组<EPBD组<EST组(P<0.05),其中EST组上消化道出血病人中有1例给予输血治疗后好转。3组术后1周并发胰腺炎比较:SES联合EPBD组和EST组均为3.3%,低于EPBD组的20.0%(P<0.05)。3组术后12个月胆总管结石复发率比较:SES联合EPBD组<EPBD组<EST组(P<0.05)。3组手术操作时间比较:SES联合EPBD组<EST组<EPBD组(P<0.05)。3组碎石器使用率比较:SES联合EPBD组<EPBD组<EST组(P<0.05)。结论:SES联合EPBD治疗直径>1 cm胆总管结石手术操作时间更短,碎石器使用率更低,近期并发症术后胰腺炎、上消化道出血明显降低,远期并发症胆总管结石复发亦能够明显降低。更多还原

【Abstract】 Objective:To investigate the clinical value of small endoscopic sphincterectomy(SES) combined with endoscopic papillary balloon dilation(EPBD) in the treatment of choledocholithiasis with a diameter greater than 1 cm.Methods:From 2011 to 2018,the cholangiolithiasis patients treated with ERCP were randomly divided into the SES combined with EPBD group,EST large incision group and EPBD group according to the treatment method(30 cases each group).The incidence rates of pancreatitis and upper gastrointestinal hemorrhage within 1 week after surgery,recurrence rate of choledocholithiasis after 12 months of surgery,operation time and intraoperative stone crusher usage in three groups were analyzed.Results:The stone extraction in all cases were successful.The intraoperative and postoperative digestive tract perforation and cholangitis were not found in three groups.The incidence rates of upper gastrointestinal bleeding in SES combined with EPBD group,EPBD group and EST group after 1 week of surgery gradually increased in turn(P<0.05),1 case with upper gastrointestinal bleeding in EST group was improved after treated with transfusion.The incidence rate of postoperative 1 week pancreatitis in the SES combined with EPBD group and EST group were 3.3%,and which was lower than that in EPBD group(20%)(P<0.05).The recurrence rates of choledocholithiasis in SES combined with EPBD group,EPBD group and EST group after 12 months of operation gradually increased in turn(P<0.05).The operation time in SES combined with EPBD group,EST group and EPBD group gradually increased in turn(P<0.05).The intraoperative stone crusher usage in SES combined with EPBD group,EPBD group and EST group gradually increased in turn(P<0.05).Conclusions:The SES combined with EPBD in the treatment of choledocholithiasis with a diameter greater than 1 cm is short time,stone crusher usage,and incidence rates of postoperative pancreatitis and upper gastrointestinal hemorrhage.The recurrence rate of choledocholithiasis of long-term complications can be reduced.更多还原