内镜下乳头球囊扩张对比十二指肠乳头括约肌小切开联合球囊扩张治疗中等大小胆总管结石的效果分析OA
Comparison of endoscopic papillary balloon dilation versus small endoscopic sphincterotomy plus balloon dilatation in the treatment of medium-sized common bile duct stones
目的 比较内镜下乳头球囊扩张(EPBD)与十二指肠乳头括约肌小切开联合球囊扩张(ESBD)治疗中等大小胆总管结石的临床效果.方法 回顾性分析2020年1月至2024年1月在湘西自治州人民医院(n=398)和张家界市人民医院(n=408)接受治疗的806例单纯性胆总管结石患者的临床资料.806例患者胆总管结石直径均在8～12 mm;根据治疗方式的不同,患者被分为EPBD组(n=401)和ESBD组(n=405).比较两组患者的一次性结石取净率、取石成功率、住院时间、住院费用及术后并发症发生率.结果 EPBD组和ESBD组在一次性结石取净率(99.3%vs 97.5%)和取石成功率(99.8%vs 99.3%)方面的差异无统计学意义(P>0.05).EPBD组在住院时间[(14.5±3.5)d vs(15.5±4.5)d,t=-3.519,P<0.001]和住院费用[(2.25±0.54)万元 vs(2.67±0.57)万元,t=-10.737,P<0.001]方面显著低于ESBD组.两组患者术后3 d肝功能(总胆红素、直接胆红素、丙氨酸氨基转移酶)和感染情况(白细胞计数、C反应蛋白、降钙素原)较术前均显著改善(P<0.05),但组间比较差异均无统计学意义(P>0.05).与ESBD组相比,EPBD组术后高淀粉酶血症发生率更高(14.7%vs 9.9%,χ2=3.938,P=0.047),但术后出血发生率更低(0 vs 1.5%,P=0.031).EPBD组和ESBD组术后胰腺炎发生率(4.7%vs 4.4%,χ2=0.001,P=0.975)以及总并发症发生率(19.7%vs 16.5%,χ2=1.150,P=0.284)差异均无统计学意义.两组均未发现严重并发症或死亡病例.结论 EPBD治疗中等大小胆总管结石的效果与ESBD相当,且患者术后出血更少、住院时间更短、治疗费用更低.
Objective To compare the clinical efficacy of endoscopic papillary balloon dilation(EPBD)versus small endoscopic sphincterotomy plus balloon dilatation(ESBD)under endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of medium-sized common bile duct stones.Methods This study retrospectively analyzed the clinical data of 806 patients with simple medium-sized(8 to 12 mm)common bile duct stones,who were treated at People's Hospital of Xiangxi Autonomous Prefecture(n=398)and Zhangjiajie People's Hospital(n=408)between January 2020 and January 2024.According to the different treatment methods,the 806 patients were divided into the EPBD group(n=401)and the ESBD group(n=405).The one-time stone clearance rate,success rate of stone removal,time of hospital stay,hospitalization cost,and postoperative complication were compared between the two groups.Results There was no statistically significant difference in terms of one-time stone clearance rate(99.3%vs 97.5%)or success rate of stone removal(99.8%vs 99.3%)between the EPBD group and the ESBD group(P>0.05).The EPBD group had significantly shorter time of hospital stay[(14.5±3.5)d vs(15.5±4.5)d,t=-3.519,P<0.001]and lower hospitalization cost[(2.25±0.54)ten thousand CNY vs(2.67±0.57)ten thousand CNY,t=-10.737,P<0.001]than those of the ESBD group.Postoperative day 3,the liver function(total bilirubin,direct bilirubin,alanine aminotransferase)and infection condition(white blood cell count,C-reactive protein,procalcitonin)in both groups were significantly improved(P<0.05),but there was no statistically significant difference between the groups(P>0.05).Compared with the ESBD group,the incidence of postoperative hyperamylasemia in the EPBD group was significantly higher(14.7%vs 9.9%,χ2=3.938,P=0.047),but the incidence of postoperative bleeding was significantly lower(0 vs 1.5%,P=0.031).There was no statistically significant difference in the postoperative pancreatitis(4.7%vs 4.4%,χ2=0.001,P=0.975)or total postoperative complication(19.7%vs 16.5%,χ2=1.150,P=0.284)between the EPBD group and the ESBD group.No severe complication or death occurred in either group.Conclusion The efficacy of EPBD for treatment of medium-sized common bile duct stones is comparable to that of ESBD,and EPBD results in less postoperative bleeding,shorter time of hospital stay,and lower treatment cost.
周国超;付华;蔡融民;杨定华;宋新;杨康
湘西自治州人民医院肝胆外科,湖南吉首 416000湘西自治州人民医院肝胆外科,湖南吉首 416000湘西自治州人民医院肝胆外科,湖南吉首 416000湘西自治州人民医院肝胆外科,湖南吉首 416000湘西自治州人民医院肝胆外科,湖南吉首 416000张家界市人民医院肝胆外科,湖南 张家界 427000
医药卫生
胆总管结石内镜逆行胰胆管造影内镜下乳头球囊扩张内镜下十二指肠乳头括约肌切开
common bile duct stonesendoscopic retrograde cholangiopancreatographyendoscopic papillary balloon dilationendoscopic sphincterotomy
《肝胆胰外科杂志》 2026 (3)
195-200,6
湖南省自然区域联合基金(2024JJ7557)湖南省卫健委科研项目(202204014693).
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