内镜下乳头括约肌小切开联合球囊扩张术治疗胆总管结石合并十二指肠乳头旁憩室的疗效及对病人血清胆红素水平的影响

doi:10.3969/j.issn.1005-6483.2020.04.019

摘要/Abstract

摘要： 目的探讨内镜下乳头括约肌小切开（sEST）联合球囊扩张术（EPBD）治疗胆总管结石合并十二指肠乳头旁憩室（JPDD）疗效及对病人血清胆红素水平影响。方法 2015年1月～2017年6月，行内镜逆行胰胆管造影术（ERCP）的胆总管结石合并JPDD病人87例，根据治疗方法不同分为两组，实验组42例，行sEST联合EPBD治疗；对照组45例，行sEST治疗。比较两组取石情况和术后一般指标，术前及术后1天的血清胆红素水平[血清总胆红素（TBil）、直接胆红素（DBil）]水平。结果实验组一次性取石成功率为92.86%，对照组为77.78%，两组比较差异有统计学意义（P<0.05）；实验组碎石器使用率和术后1年结石复发率分别为4.76%和2.38%，对照组分别为20.00%和15.56%，两组比较差异有统计学意义（P<0.05）；实验组住院时间（7.85±2.17）天，对照组为（9.72±2.85）天，两组比较差异有统计学意义（P<0.05）。术后1 天，实验组血清TBil及DBil水平分别为（156.06±51.27）μmol/L和（92.85±29.74）μmol/L，对照组分别为（171.72±56.48）μmol/L和（105.42±34.81）μmol/L，均较术前明显降低（P<0.05），但组间比较差异无统计学意义（P>0.05）。结论 sEST联合EPBD治疗胆总管结石合并JPDD病人可提高一次性取石成功率、减少碎石器使用率和结石复发率，病人术后恢复较快，且能有效改善其血清胆红素水平。

关键词: 胆总管结石, 十二指肠乳头旁憩室, 内镜下乳头括约肌小切开, 球囊扩张术

Abstract: Objective To investigate the efficacy of endoscopic sphincterotomy（sEST）combined with balloon dilatation（EPBD）in the treatment of common bile duct stones combined with duodenal papillary diverticulum（JPDD）and serum bilirubin levels. Methods The clinical data of 87 patients with common bile duct stones and JPDD who underwent endoscopic retrograde cholangiopancreatography（ERCP）in our hospital from January 2015 to June 2017 were retrospectively analyzed.Among them，42 patients were treated with sEST combined with EPBD（experimental group）.45 patients were treated with sEST（control group）.The stone removal status and postoperative general indexes，the serum bilirubin levels [serum total bilirubin（TBil），direct bilirubin（DBil）] before surgery and 1 day after surgery of the two groups were compared. Results The success rate of one-time stone removal in the experimental group was 92.86%，which was significantly higher than 77.78% in the control group（P<0.05）.The rate of lithotripsy in the experimental group and the recurrence rate of one year after surgery were 4.76% and 2.38%，respectively，which were significantly lower than the control group's 20.00% and 15.56%（P<0.05）.TThe hospital stay in the experimental group was（7.85±2.17）d，which was shorter than that of the control group（9.72±2.85）d（P<0.05）.1 day after surgery，the serum levels of TBil and DBil in the experimental group were（156.06±51.27）μmol/L and（92.85±29.74）μmol/L，respectively，the serum TBil and DBil levels in the control group were（171.72±56.48）μmol/L and（105.42±34.81）μmol/L，respectively，which were significantly lower than those before surgery（P<0.05）.But there were no significant differences between the two groups（P>0.05）. Conclusion sEST combined with EPBD in the treatment of common bile duct stones combined with JPDD can significantly improve the success rate of one-time stone removal，reduce the use of lithotripsy and stone recurrence rate，patients recover faster，and can effectively improve their serum bilirubin levels.

Key words: common bile duct stones, duodenal papillary diverticulum, endoscopic sphincterotomy, balloon expansion

雷婷李茜蒋丽丽孙金山张建红刘萍聂占国. 内镜下乳头括约肌小切开联合球囊扩张术治疗胆总管结石合并十二指肠乳头旁憩室的疗效及对病人血清胆红素水平的影响[J]. 临床外科杂志, 2020, 28(4): 358-360.

LEI Ting, LI Qian, JIANG Lili, et al.. Effect of sEST combined with EPBD on common bile duct stones combined with duodenal papillary diverticulum and its effect on serum bilirubin levels[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(4): 358-360.

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