内镜下乳头括约肌切开术联合不同时长气囊扩张术治疗胆总管结石的疗效观察

摘要 目的：探讨内镜下乳头括约肌小切开术( endoscopic sphincterotomy，EST)联合不同时长持续时间十二指肠乳头气囊扩张术（Endoscopic papillary balloon dilatation,，EPBD）对胆总管结石患者治疗效果差异。方法：选择2018年1月至2018年12月于我院接受EST联合EPBD治疗的92例胆总管结石患者为研究对象， 按照其术中气囊扩张时间的不同将其分为A组（46例，扩张时间20 s）、B组（46例，扩张时间40 s），对比两组患者一次净石率、机械碎石率、操作时间及X线暴露时间，对比两组患者术前及术后肝功能指标，术后12 h血淀粉酶，对比两组患者术后胰腺炎、消化道出血、胆道感染、穿孔等并发症的发生率。结果：（1）对比显示两组患者一次净石率、机械碎石率、操作时间、X线暴露时间及12 h血淀粉酶对比差异不具有统计学意义（P>0.05）；（2）术前两组患者总胆红素(Total bilirubin，TBIL)、谷氨酸转氨酶(Glutamate aminotransferase，ALT)、碱性磷酸酶(alkaline phosphatase，ALP)对比差异不具有统计学意义（P>0.05），术后两组患者上述指标均较治疗前出现明显的下降，但组间比较无差异（P>0.05）；（3）A组患者术后各类并发症发生率为4.35 %（2/46），B组患者术后各类并发症发生率为17.39 %（8/46），两组对比差异具有统计学意义（P<0.05）。结论：EST联合EPBD对胆总管结石具有较好的治疗效果，术中不同气囊扩张时间不会对手术成功率、手术时间等指标造成影响，但长时间扩张存在增加术后出血的风险，建议在能够正常实施手术的情况下尽量控制术中气囊扩张时间。

Observation of Therapeutic Effect of Endoscopic Sphincterotomy Combined with Different Duration of Endoscopic Papillary Balloon Dilatation on Patients with Common Bile Duct Stones

ABSTRACT Objective: To explore the Endoscopic sphincterotomy combined with different durations of endoscopic papillary balloon dilatation in patients with common bile duct stones. Methods: A total of 92 patients with common bile duct stones who underwent EST combined with EPBD in our hospital from January 2018 to December 2018 were selected as the study subjects. They were divided into group A according to the intraoperative balloon dilation time (46 patients, dilatation expansion time 20 s), group B (46 patients, dilatation expansion time 40 s), compared the two groups of patients with a net stone rate, mechanical lithotripsy rate, operation time and X-ray exposure time, compared the two groups of patients with liver function indicators before and after surgery The blood amylase at 12 hours after operation was compared with the incidence of complications such as pancreatitis, gastrointestinal bleeding, biliary infection, and perforation in the two groups. Results: (1) The comparison showed that there was no statistically significant difference between the two groups of patients in the rate of clean stones, mechanical lithotripsy, operating time, X-ray exposure time, and 12 h blood amylase (P>0.05). (2) The differences in TBIL, ALT, and ALP between the two groups of patients before surgery were not statistically significant (P>0.05). The above indicators in the two groups of patients showed a significant decrease compared with that before treatment, but there was no difference between the groups(P>0.05). (3) The incidence of various postoperative complications in group A was 4.35 % (2/46), and the incidence of various postoperative complications in group B was 17.39 %(8/46). The difference between the two groups was statistically significant(P<0.05). Conclusion: EST combined with EPBD has a good therapeutic effect on common bile duct stones. Different balloon inflation times during the operation will not affect the success rate and operation time, but long-term expansion will increase the risk of postoperative bleeding. In the case of surgery, try to control the balloon dilation time during the operation.