摘要
目的探讨十二指肠乳头括约肌扩张术(Endoscopic papillary balloon dilatation,EPBD)联合单猪尾胰管塑料支架治疗胆总管小结石(直径<1.0 cm)效果。方法回顾性分析内蒙古林业总医院2017年9月~2019年9月内镜逆行性胰胆管造影术(Endoscopic retrograde colangiopancreatography,ERCP)治疗胆总管小结石患者60例的资料,随机分两组,EPBD组采用EPBD联合胰管支架置入(n=31);EST组采用十二指肠乳头括约肌切开术(Endoscopic sphincterotomy,EST)联合鼻胆管引流术(Endoscopic nasobiliary drainage,ENBD)(n=29)。比较两组取石成功率、术后并发症的发生情况,观察EPBD组支架脱落、内镜取出情况。结果EPBD组及EST组分别30例(96.8%)、28例(96.6%)完整取石(P>0.05),ERCP术后急性胰腺炎(post-ERCP pancreatitis,PEP)分别为9.7%、10.3%(P>0.05),EST组出血1例,无穿孔,EPBD组无出血、穿孔发生。EPBD组术后1 d内支架脱落1例;术后2周未脱落1例,内镜下成功取出;其余均2周内安全脱落。结论EPBD组与EST组取石成功率相近,PEP无明显升高,但术后出血率降低,是一种安全、有效的治疗手段。
Objective To explore the effect of Endoscopic Papillary Balloon Dilatation(EPBD)combined with single pigtail plastic pancreatic duct stent in the treatment of common bile duct small stone(diameter<1.0 m).Methods Clinical data of 60 patients with common bile duct small stone who treated by endoscopic retrograde colangiopancreatography(ERCP)from September 2017 to September 2019 in Inner Mongolia Forestry General Hospital were retrospectively investigated.Totally 60 patients were randomly divided into two groups,EPBD group given EPBD with pancreatic duct stenting(n=31)and EST group given Endoscopic sphincterotomy(EST)with Endoscopic Nasobiliary Drainage(ENBD)(n=29).The success rate of the operation and the incidences of postoperative complications in the two groups were compared,and the stent shedding and endoscopic removal in the EPBD group were observed.Results The 30 cases of successful stone extraction in the EPBD group(96.8%)and 28 cases in the EST group(96.6%)(P>0.05).The incidences of post-ERCP pancreatitis(PEP)were 9.7%in the EPBD group and 10.3%(P>0.05)in the EST group.The EST group had no perforation but 1 case of gastrointestinal hemorrhage,while no bleeding or perforation occurred in the EPBD group.There was 1 case of stent shedding within 1 day after ERCP,and 1 case of stent under endoscopy removed which failed to fall off 2 weeks after surgery in the EPBD group.The rest were safely excreted outside through the digestive tract within 2 weeks.Conclusion The success rate of stone extraction in the EPBD group is similar to that in the EST group,and the postoperative bleeding rate is reduced in the EPBD group with no significant increase in PEP,which indicate EPBD is a safe and effective treatment for common bile duct stones.
作者
郎绪龙
郑洁
张莉
董学刚
潘志广
曹金恒
LANG Xulong;ZHENG Jie;ZHANG Li;DONG Xuegang;PAN Zhiguang;CAO Jinheng(Mirror Chamber,Inner Mongolia Forestry General Hospital,Hulunbuir022150,China)
出处
《中国现代医生》
2020年第28期77-79,83,共4页
China Modern Doctor
基金
内蒙古自治区卫生和计划生育委员会科研计划项目(20171106)。
