摘要
目的评价应用乳头气囊扩张(endoscopic papillary balloon dilatation,EPBD)联合乳头括约肌切开(endoscopic sphincterotomy,EST)治疗胆总管结石的疗效及其对结石复发的影响.方法选择2014-01/2016-01于天津南开医院行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopan creatography,ERCP)治疗的胆总管结石患者100例,采用随机数字表法分为对照组和实验组,分别给予经ERCP下EST取石术和乳头括约肌小切开(limited endoscopic sphincterotomy,LEST)联合EPBD,比较两组患者的一次成功率和总成功率,ERCP术后并发症发生率,术后进行随访,绘制患者术后结石复发的Kaplan-Meier生存曲线,并应用Cox回归模型探究影响患者术后复发的危险因素.结果对照组和实验组的结石最大直径(t=-1.055,P=0.294)、多发结石比例(χ~2=0.644,P=0.422)、胆管最大直径(t=-0.820,P=0.414)以及取石总成功率(94.0%和100.0%,χ~2=1.375,P=0.241)间均无统计学差异,对照组和实验组的1次取石成功率分别为84.0%和96.0%,差异有统计学意义(χ~2=4.332,P=0.037).对照组和实验组ERCP术后并发症的发生率分别为17.02%和6.0%,差异有统计学意义(χ~2=4.337,P=0.036).对取石成功的97例患者进行随访,共发生结石复发11例,其中,对照组和实验组ERCP术后并发症的发生率分别为17.02%和6.0%,差异无统计学意义(χ~2=2.927,P=0.087),Log-rank显示,实验组的胆结石复发风险显著低于对照组(HR=0.285,95%CI:0.095-0.888,P=0.044).多因素Cox回归分析显示,多次内镜操作、胆总管成角≤145o和EST是ERCP术后复发的危险因素.结论 EPBD联合LEST治疗胆总管结石的一次成功率和安全性较高,结石远期复发风险较低;多次内镜操作、胆总管成角≤145o是ERCP术后复发的危险因素.
AIM To evaluate the efficacy of endoscopic papillary balloon dilatation （EPBD） combined with endoscopic sphincterotomy （EST） in the treatment of common bile duct stones and to identify the factors affecting the recurrence of stones. METHODS One hundred patients with choledocholithiasis who underwent endoscopic retrograde cholangiopan- creatography （ERCP） at our hospital between January 2014 and January 2016 were randomly divided into a control group and an expenental group. The patients in the control group and experimental group were given F_ST lithotomy and small-incision endoscopic sphincterotomy （SEST） combined with EPBD, respectively. The one- time success rate, total success rate, and the incidence of complications after ERCP were comparatively analyzed. The Kaplan-Meier survival curve of patients with postoperative stone recurrence was plotted, and the Cox regression model was used to explore the risk factors for postoperative recurrence in patients. The maximum diameter of the stones （t = -1.055, P = 0.294）, the rate of multiple stones （χ2 = 0.644, P = 0.422）, the maximum diameter of bile duct （t = -0.820, P= 0.414）, and the stone removal success rate （94.0% and 100.0%, χ2= 1.375, P = 0.241） differed significantly between the control group and the experimental group. There was no significant difference in the one-time success rate between the control group and the experimental group （84.0% and 96.0%, χ2= 4.332, P = 0.037）. The incidenceof complications after ERCP in the control group and experimental group was 17.02% and 6.0%, respectively （ χ2 = 4.337, P = 0.036）. A total of 97 patients were followed, with stone recurrence occurring in 11 cases. In the 97 patients followed, the incidence of complications after ERCP in the control group and experimental group was 17.02% and 6.0%, respectively （ χ2=2.927, P = 0.087）. Log-rank test showed that the risk of gallstone recurrence in the experimental group was significantly lower than that in the control group （HR = 0.285, 95%CI： 0.095-0.888, P = 0.044）. Multivariate Cox regression analysis showed that multiple endoscopic procedures, common bile duct angulation （≤ 145°）, and EST were risk factors for ERCP recurrence. CONCLUSION The success rate and safety of EPBD combined with LEST in the management of common bile duct stones are high, and the risk of long-term stone recurrence is low. Multiple endoscopic operations and common bile duct angulation （≤ 145°） are risk factors for stone recurrence.
出处
《世界华人消化杂志》
CAS
2018年第4期263-269,共7页
World Chinese Journal of Digestology
关键词
胆总管结石
经内镜逆行性胰胆管造影术
乳头气囊扩张
乳头括约肌切开
Common bile duct stones
Endoscopic retrogradecholangiopancreatography
Endoscopic papillary balloondilatation
Endoscopic sphincterotomy
