EST小切开联合EPBD治疗胆总管结石合并乳头旁憩室的临床分析

摘要

目的：探讨EST小切开联合EPBD治疗胆总管结石合并乳头旁憩室的疗效及风险。方法：选取2011年4月-2015年4月山西医科大学第一医院行内镜治疗胆总管结石合并乳头旁憩室的患者87例，其中观察组38例行乳头括约肌小切开联合乳头气囊扩张术（EPBD）取石，对照组49例行标准乳头括约肌切开术（EST）取石，观察两组取石成功率、术中碎石率及术后并发症等。结果：观察组一次性取净结石36例（94.7%），术中碎石4例（10.5%）；对照组一次性取净结石47例（95.9%）；术中碎石8例（16.3%），两组比较差异无统计学意义（P>0.05）。观察组术后高淀粉酶血症7例（18.4%），操作时间（34.05±13.60）min，对照组术后高淀粉酶血症19例（38.8%），操作时间（40.51±8.99）min，比较差异有统计学意义（P<0.05）。结论：EST小切开联合EPBD治疗胆总管结石合并乳头旁憩室与标准EST相比，可降低术后并发症，并缩短操作时间，是治疗胆总管结石合并乳头旁憩室安全、高效的微创方法，值得在临床工作中进一步推广。%Objective: To evaluate the therapeutic efficacy and safety of EST joint EPBD for treating common bile duct stones combined nipple diverticulum.Method: 87 patients with common bile duct stones combined nipple diverticulum in the First Hospital of Shanxi Medical University from April 2011 to April 2015 were selected. 38 patients in observation group were treated with limited EST plus EPBD (ESBD), and 49 patients conventional EST (EST) treatment in control group. The rate of removing stone success, mechanical brokenstone, and complications was observed.Result: The rate of removing stone success of the observation group was 94.7%(36/38), and that of the control group was 95.9% (47/49). The rate of mechanical brokenstone was 10.5% (4/38), and that of the control group was 16.3% (8/49). There were no significant differences between the two groups (P>0.05). The rate of complications of the observation group and control group was 18.4% (7/38) and 38.8%(19/49), and operating time was (34.05±13.60) min and (40.51±8.99) min, respectively, the differences were statistically significant (P<0.05).Conclusion:Contrast to the EST joint EPBD for treating common bile duct stones combined nipple diverticulum and the standard EST, the former can reduce the rate of complications and shorten the time of operation. AS a safe and effective treatment, it is worthy of clinical application.