目的：比较内镜下乳头括约肌切开术（endoscopicsphincterotomy，EST）、乳头气囊扩张术（en-doscopicpapillaballoondilatation，EPBD）和乳头括约肌小切开联合气囊扩张术（limitedendoscopicsphincterotomycombinedwithendoscopicballoondilatation，LEST+EPBD）三种方法治疗胆总管结石的疗效。方法回顾性分析上海交通大学附属仁济医院2011年7月至2014年7月398例胆总管结石患者的临床资料，按照治疗方式分为单纯乳头括约肌切开术组（EST组，n=228例）、乳头气囊扩张术组（EPBD组，n=36例）和乳头括约肌小切开联合乳头气囊扩张术组（LEST+EPBD组，n=134例），比较分析三组的取石成功率、平均住院天数、平均住院费用、单枚结石平均最大直径、术后短期（24h内）血淀粉酶的改变，以及近期（术后1周内）并发症如胰腺炎、出血、穿孔、胆道感染和远期（术后2年内）并发症如反流性胆管炎、结石复发等情况。结果三组性别组成、年龄、住院天数，取石成功率和一次取石成功率，差异均无统计学意义（P＞0.05）。与EST组比，EPBD组和LEST+EPBD组住院费用较高，且LEST+EPBD组费用最高，差异有统计学意义（P＜0.05）。与EST组及EPBD组比，LEST+EPBD组的结石直径最大，差异有统计学意义（P＜0.05）。三组近期并发症比较， EPBD组胰腺炎发生率高于其他两组（P＜0.05），而LEST+EPBD组与EST组比较，差异无统计学意义（P＞0.05）。其他近期并发症如高淀粉酶血症、出血、穿孔、胆道感染发生率，三组比较差异无统计学意义（P＞0.05）。术后远期并发症中，反流性胆管炎三组间无统计学差异（P＞0.05），但LEST+EPBD组结石复发率较EST组低，差异有统计学意义（P＜0.05）。结论 LEST+EPBD治疗胆总管结石是安全有效的，值得临床推广应用。%objective To study the effects of endoscopic sphincterotomy (EST), endoscopic papilla balloon dilatation (EPBD) and limited endoscopic sphincterotomy combined with endoscopic papilla balloon dilatation (LEST+EPBD) on common bile duct stones. Methods A total of 398 patients with common duct stones treated in Renji Hospital from Jul. 2011 to Jul. 2014 were divided into three groups: endoscopic sphincterotomy group (EST group, n=228), endoscopic papilla balloon dilatation group (EPBD group, n=36) and limited endoscopic sphincterotomy combined with endoscopic papilla balloon dilatation group (LEST+EPBD group, n=134). The differences of stones diameter, success rate of stone removal, hospitalization stays, total expenses, the average maximum diameter of single stones, postoperative short-term (within 24 h) analysis of blood amylase changes, the short-term (within 1 week postoperation) complications such as pancreatitis, bleeding, perforation, biliary tract infection and long-term (within 2 years) complications such as reflux cholangitis, stones recurrence, were compared among three groups. Results There were no significant difference in gender composition, age, hos-pitalization stays and stone removal rates among three groups (P>0.05). Compared with the EST group, there were higher hospitalization expenses in EPBD group and LEST+EPBD group, and highest in LEST+EPBD group (P<0.05). Compared with the EST group and the EPBD group, the average maximum diameter of stones in LEST+EPBD group was biggest (P<0.05). For short-term complications, EPBD group had the highest incidence of pancreatitis among three groups (P<0.05); there was no significant difference in hyperamylasemia, bleeding, perforation and biliary tract infection among three groups (P>0.05). For long-term complications, there was no significant difference in reflux cholangitis among three groups (P>0.05), but LEST+EPBD group had lower stone recurrence rate than that in EST group (P<0.05). Conclusion LEST+EPBD is safer and more effective for com-mon bile duct stones than EST or EPBD treatment. Therefore, LEST+EPBD is worthy of clinical application.
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