摘要：
Objective To evaluate the clinical efficacy of small endoscopic sphincterotomy combined large-bal-loon dilation in treatment of common bile duct stones 1.0~2.5 cm in diameter. Methods 426 patients with large common bile duct (CBD) stones 1.0~2.5 cm in size were reviewed in our hospital between June 2010 and June 2014. They were randomized underwent small endoscopic sphincterotomy combined large-balloon dilation (SESPLBD) (n=218) or endoscopic sphincterotomy (EST) ( n= 208) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results SESPLBD had higher complete duct clearance in one session (95.41 % vs. 93.75%), but there was no statistical significant difference. Bleeding was much less occurred in SESPLBD than in EST (2.29 % vs. 7.69 %, P= 0.025), especially when the stones were bigger than 1.5 cm in diameter. Mechanical lithotripsy was performed less in SESPLBD (13.76%vs 25.96 %, P=0.002), especially when the stones were 1.5 ~2.0 cm in diameter. There was no statistical significant difference in the incidence rate of post-ERCP pancreatitis (9.17 % vs. 6.73 %,P = 0.452), hyperamylasemia (19.72 % vs. 18.27 %,P = 0.796), perforation and death. Conclusions SESPLBD could be a safe method for large bile duct stones 1.0~2.5 cm in size. Compared with routine EST, it had less bleeding rate and mechanical lithotripsy requirement without increasing the incidence rate of post-ERCP pancreatitis or hyperamylasemia.%目的 评价十二指肠乳头小切开+大气囊扩张(ESLBD)治疗直径1.0~2.5 cm胆总管结石的临床价值.方法 收集2010年6月-2014年6月该院收治的直径1.0~2.5 cm胆总管结石病例,共426例,随机分为两组,一组进行ESLBD治疗(治疗组,218例),一组进行传统十二指肠乳头大切(常规EST对照组,208例),从治疗成功率、安全性和术后临床并发症的发生情况等方面评估ESLBD治疗方法的安全性及临床价值.结果 治疗组所有结石一次性成功率为95.41%,略高于对照组,但差异无统计学意义.治疗组发生出血率为2.29%,机械碎石率为13.76%,明显低于对照组(7.69%,25.96%;P=0.025,0.002),尤其是在直径大于1.5 cm胆总管结石病例中;治疗组发生术后急性胰腺炎比例为9.17%,术后高淀粉酶血症比例为19.72%,与对照组(6.73%和18.27%)比较差异无统计学意义(P=0.452和P=0.796),两组穿孔率无差异,无死亡病例.结论 ESLBD方法治疗直径1.0~2.5 cm胆总管结石是安全可行的,相对于传统大切开治疗,能显著降低出血率和机械碎石率,不增加胰腺炎和高淀粉酶血症的比例,其并发症率低,值得临床推广.
