小切开EST联合EPBD与单纯EST对85岁以上老年胆总管结石患者疗效的比较

目的:对比内镜下十二指肠乳头括约肌(expressed sequence tags,EST)小切开术联合内镜下十二指肠乳头括约肌扩张术(endoscopic papillary balloon dilation,EPBD)与单纯EST对85岁以上老年胆总管结石患者的疗效。方法:选择我院于2014年1月～2020年2月收治的85岁以上老年胆总管结石患者150例,根据入院顺序随机分成两组,每组各75例,给予对照组单纯小切开EST术治疗,给予研究组小切开EST+EPBD术治疗。对比两组的一次取石成功率、机械碎石、结石复发率等指标;术中操作时间、术中出血量、住院天数、术后排便天数等临床指标;术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛等并发症的总发生率。结果:研究组一次取石成功率显著高于对照组,机械碎石、结石复发率均显著低于对照组(P0.05);研究组的术中操作时间、术中出血量、住院天数、术后排便天数均显著低于对照组(P0.05);研究组术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛、术后迟发性出血等并发症的总发生率为9.33%(7/75),显著低于对照组37.33%(28/75),差异具有统计学意义(P0.05)。结论:小切开EST联合EPBD对85岁以上老年胆总管结石患者的疗效显著,该方法可有改善患者临床指标,降低术后并发症发生率,值得推荐至临床广泛应用。

Comparison of the Efficacy of Small Incision EST Combined with EPBD and EST Alone in Elderly Patients with Common Bile Duct Stones Over 85 Years Old

ABSTRACT Objective: Compare the efficacy of endoscopic duodenal papillary sphincter incision (small incision EST) with endoscopic duodenal papillary sphincter dilatation (EPBD) and EST alone in elderly patients with common bile duct stones over 85 years old. Methods: 150 cases of elderly patients with common bile duct stones over 85 years old who were treated in our hospital from January 2014 to February 2020 were selected as the research object. They were randomly divided into two groups according to the admission order, with 75 cases in each group. Patients in the control group were treated with minimal incision EST, and patients in the study group were treated with minimal incision EST + EPBD. Compare the two groups of patients with the success rate of one stone removal, mechanical lithotripsy, and stone recurrence rate. Compare clinical indicators such as intraoperative time, intraoperative blood loss, length of hospital stay, and postoperative defecation days between the two groups of patients; The total incidence of postoperative biliary tract infection, acute pancreatitis, hyperamylase, and postoperative abdominal pain was compared between the two groups of patients. Results: The success rate of one stone removal in the study group was significantly higher than that in the control group, and the recurrence rates of mechanical lithotripsy and stone were significantly lower than those in the control group (P<0.05). The operation time, intraoperative blood loss, length of hospital stay, and postoperative defecation days were significantly lower in the study group than in the control group (P<0.05). The total incidence of postoperative biliary tract infection, acute pancreatitis, hyperamylase, postoperative abdominal pain, and postoperative delayed bleeding in the study group was 9.33 % (7/75), which was significantly lower than the control group of 37.33 % (28/75, P<0.05). Conclusion: Small incision EST combined with EPBD has a significant effect on elderly patients with common bile duct stones over 85 years of age. This method can improve clinical indicators and reduce the incidence of postoperative complications. It is worth recommending to be widely used in clinical practice.