内镜下乳头球囊扩张术治疗胆总管结石的扩张时间
Dilation Time in Endoscopic Papillary Balloon Dilation for Common Bile Duct Stones.
作者信息
Shen Yong-Hua, Yang Liu-Qing, Yao Yu-Ling, Wang Lei, Zhang Yi-Yang, Cao Jun, He Qi-Bin, Zou Xiao-Ping, Li Yun-Hong
机构信息
Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, Jiangsu Province, China.
出版信息
Surg Laparosc Endosc Percutan Tech. 2017 Oct;27(5):351-355. doi: 10.1097/SLE.0000000000000431.
BACKGROUND
To assess the short-term outcomes after endoscopic sphincterotomy (EST) plus endoscopic papillary balloon dilation (EPBD) versus EPBD alone and appropriate balloon dilation time in EPBD alone.
MATERIALS AND METHODS
A total of 413 patients with common bile duct stones (CBDSs) were included in the EST plus EPBD group and 84 were in the EPBD alone group. We retrospectively evaluated the safety and efficacy between EST plus EPBD and EPBD alone group. The patients in EPBD alone group were assigned to dilation time ≥5 minutes group (n=35) and time <5 minutes group (n=49). Further, we preliminarily discussed the influence of balloon dilation time on the procedure-related complications.
RESULTS
Compared with EST plus EPBD, the patients in EPBD alone group were younger [56.6 (range: 18 to 95) vs. 65.1 (24 to 92) y; P=0.006], had smaller diameter of the largest stone [10.4 (range: 3 to 20) vs. 12.3 (5 to 30) mm; P<0.001] and were lesser frequently performed with jaundice [22 (26.2%) vs. 189 (45.8%); P=0.001]. The mean duration of postoperative hospital stay in EPBD alone group was significantly shorter than EST plus EPBD group [6.3 (range: 1 to 18) vs. 9.2 (1 to 44) d; P<0.001]. The patients in EPBD alone group had higher risk of post endoscopic retrograde cholangiopancreatography pancreatitis than EST plus EPBD group [11 (13.1%) vs. 22 (5.3%); P=0.009]. Patients in the dilation time <5 minutes group had higher risk to suffer from postoperative pancreatitis than the EST plus EPBD group [9 (18.4%) vs. 22 (5.3%); P=0.002], while patients in the dilation time ≥5 minutes group had less procedure-related hemorrhage than the EST plus EPBD group [0 vs. 36 (8.7%); P=0.047].
CONCLUSION
Long balloon dilation time in EPBD alone is safe and effective in treating CBDSs.
背景
评估内镜括约肌切开术（EST）联合内镜乳头球囊扩张术（EPBD）与单纯EPBD后的短期疗效以及单纯EPBD中合适的球囊扩张时间。
材料与方法
EST联合EPBD组纳入413例胆总管结石（CBDS）患者，单纯EPBD组纳入84例。我们回顾性评估了EST联合EPBD组与单纯EPBD组之间的安全性和有效性。将单纯EPBD组患者分为扩张时间≥5分钟组（n = 35）和扩张时间<5分钟组（n = 49）。此外，我们初步探讨了球囊扩张时间对手术相关并发症的影响。
结果
与EST联合EPBD相比，单纯EPBD组患者更年轻[56.6（范围：18至95）岁 vs. 65.1（24至92）岁；P = 0.006]，最大结石直径更小[10.4（范围：3至20）mm vs. 12.3（5至30）mm；P < 0.001]，黄疸发生率更低[22（26.2%） vs. 189（45.8%）；P = 0.001]。单纯EPBD组术后平均住院时间明显短于EST联合EPBD组[6.3（范围：1至18）天 vs. 9.2（1至44）天；P < 0.001]。单纯EPBD组患者内镜逆行胰胆管造影术后胰腺炎的风险高于EST联合EPBD组[11（13.1%） vs. 22（5.3%）；P = 0.009]。扩张时间<5分钟组患者术后胰腺炎的风险高于EST联合EPBD组[9（18.4%） vs. 22（5.3%）；P = 0.002]，而扩张时间≥5分钟组手术相关出血少于EST联合EPBD组[0 vs. 36（8.7%）；P = 0.047]。
结论
单纯EPBD中较长的球囊扩张时间治疗CBDS是安全有效的。
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