内镜乳头球囊间断扩张术联合内镜括约肌切开术治疗胆管结石。
Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones.
机构信息
Department of Gastroenterology, the People's Hospital, Affiliated to Jiangsu University, Zhenjiang 212002, Jiangsu Province, China.
出版信息
World J Gastroenterol. 2013 Apr 21;19(15):2425-32. doi: 10.3748/wjg.v19.i15.2425.
AIM
To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones.
METHODS
From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed.
RESULTS
First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P = 0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P = 0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P = 0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P = 0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P = 0.00).
CONCLUSION
The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.
目的
比较内镜下乳头球囊扩张术（EPBID）与内镜下括约肌切开术（EST）治疗胆总管结石的有效性和安全性。
方法
2011 年 3 月至 2012 年 5 月，对 560 例患者进行了内镜逆行胰胆管造影术，其中 262 例患有胆总管结石。共有 206 例胆总管结石患者入组并随机分为 EPBID 组（使用 10-12mm 扩张球囊）和 EST 组（每组 103 例）。两组均使用常规网篮或球囊取石。取石后常规行内镜鼻胆管引流。
结果
EPBID 组 94 例（91.3%）患者首次取石成功，EST 组 75 例（72.8%）患者首次取石成功。两组手术时间无统计学差异。EPBID 组和 EST 组早期并发症总发生率分别为 2.9%和 13.6%，研究和随访过程中无死亡病例。多因素回归分析显示，取石成功率与取石方法[比值比（OR）：5.35；95%可信区间（CI）：2.24-12.77；P=0.00]、结石横径（OR：2.63；95%CI：1.19-5.80；P=0.02）和憩室存在与否（OR：2.35；95%CI：1.03-5.37；P=0.04）有关。术后胰腺炎与 EST 取石方法（OR：5.00；95%CI：1.23-20.28；P=0.02）和是否行胰胆管造影（OR：0.10；95%CI：0.03-0.35；P=0.00）有关。
结论
与 EST 组相比，EPBID 组取石成功率更高，胰腺炎发生率更低。
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