天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 620-623.doi: 10.11958/20170499

• 临床研究 • 上一篇    下一篇

EST 联合 EPLBD 不同扩张时间在胆总管结石中的应用

门昌君，张国梁△   

  1. 天津市第一中心医院消化科（邮编 300192）
  • 收稿日期:2017-04-21 修回日期:2017-05-19 出版日期:2017-06-15 发布日期:2017-07-05
  • 通讯作者: △通讯作者 E-mail: yzxxhkmcj@163.com E-mail:zgl_022@126.com
  • 作者简介:门昌君（1981），女，主治医师，硕士，主要从事消化道肿瘤及内镜下诊疗研究
  • 基金资助:
    天津市卫计委 2015 年引进新技术填补空白项目（2015043）

The application of endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in the treatment of choledocholithiasis

MEN Chang-jun，ZHANG Guo-liang△   

  1. Department of Gastroenterology, Tianjin First Center Hospital, Tianjin 300192, China
  • Received:2017-04-21 Revised:2017-05-19 Published:2017-06-15 Online:2017-07-05
  • Contact: △Corresponding Author E-mail：yzxxhkmcj@163.com E-mail:zgl_022@126.com

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摘要： 目的 探讨内镜下乳头肌切开（EST）联合内镜下十二指肠乳头大球囊扩张术（EPLBD）下不同扩张时间对 治疗胆总管结石的影响。方法 选取采用 EST 联合 EPLBD 进行胆总管结石治疗的患者 128 例，按不同球囊扩张时 间分为 0 min 组、1 min 组、3 min 组及 5 min 组，各组球囊扩张至所需直径后分别维持相应时间减压拔除球囊。术后 常规监测及治疗，所有患者观察 48 h 以上确定是否发生胰腺炎、出血等早期并发症。根据结石最大直径、扩张直径、 球囊扩张直径、内镜逆行胰胆管造影（ERCP）操作时间、碎石器使用情况来评估 EPLBD 的有效性，以术后胰腺炎、出 血、穿孔等并发症发生情况评估其安全性。结果 所有患者均顺利取石。各组结石最大直径、胆管扩张直径以及球 囊扩张直径差异均无统计学意义。各组患者均无出血、穿孔、胆道感染及急性胰腺炎发生；各组碎石器使用率差异 无统计学意义；0、1 及 3 min 组 ERCP 操作时间呈先降后升趋势（P＜0.05），但 3 min 组操作时间与 0 min 组比较差异 无统计学意义；各组高淀粉酶血症发生率差异无统计学意义。结论 EST+EPLBD 不同扩张时间治疗胆总管结石早 期安全有效，其中 1 min 组疗效较好。

关键词: 胆总管结石, 时间因素, 扩张术, 内镜下乳头肌切开, 内镜下十二指肠乳头大球囊扩张

Abstract: Objective To investigate the effect of endoscopic sphincterotomy（EST) combined with endoscopic papillary large balloon dilation（EPLBD) in the treatment of common bile duct stones. Methods A total of 128 patients treated with EST combined with EPLBD for common bile duct stones were divided into 0 min group, 1 min group, 3 min group and 5 min group, according to the different balloon expansion times. The balloon was extended to the required diameter and was maintained to the corresponding time, and then decreased the pressure to remove the balloon. Patients were given routine monitoring and treatment after operation. All patients were observed more than 48 h to determine whether there were early complications such as pancreatitis and bleeding. The effectiveness of EPLBD was evaluated by the stone diameter, expansion balloon diameter, ERCP operation time and use of stone breaker. The safety was evaluated by the occurrence of complications including postoperative pancreatitis, bleeding and perforation. Results All patients were successfully removed stones. There were no significant differences in the maximum diameter of stone, the diameter of bile duct dilatation and the diameter of balloon dilatation between groups. No bleeding, perforation, biliary tract infection and acute pancreatitis were found in patients. There were no significant differences in the utilization rates of stone breaker between groups. ERCP operation times showed a trend of decreased first and then increased in 0, 1 and 3 min groups (P＜ 0.05). There was no significant difference in ERCP operation time between 3 min group and 0 min group. There were no significant differences in incidence rates of high amylase between groups. Conclusion EST combined with EPLBD is a safe and effective treatment for early stage of larger common bile duct stones, of which 1 minute group shows better effect.

Key words: choledocholithiasis, time factors, dilatation, endoscopic sphincterotomy, endoscopic papillary large balloon dilation