经内镜乳头小切开加大气囊扩张治疗十二指肠乳头旁憩室合并胆总管大结石.docVIP

精品论文 参考文献 经内镜乳头小切开加大气囊扩张治疗十二指肠乳头旁憩室合并胆总管大结石 DOI：10.7504/nk2016010203 中图分类号：692 文献标识码：A 　　摘要：目的 探讨内镜下十二指肠乳头小切开加大气囊扩张治疗十二指肠乳头旁憩室合并较大胆总管结石的安全性和有效性。方法 2011年2月至2015年8月收治胆总管结石直径ge;10mm的患者，分为EST组和SEST+EPLBD组，EST组单纯行乳头切开；SEST+EPLBD组先行EST，切开乳头＜5mm，再用相应直径大气囊扩张乳头，然后进行相应的取石、碎石操作。两组术后均常规行鼻胆引流管引流3天，并造影复查。比较两组取石成功率、取石次数、碎石器使用率及近期并发症发生率。结果 EST组40例和SEST+EPLBD组42例，总取石成功率分别为95.0%（38/40）和97.6%（41/42）,P＞0.05，两组总取石成功率比较无统计学意义，其中一次取石成功率分别为；65.0%（26/40）和90.4%（38/42）,P＜0.05，两组比较差异有统计学意义；机械碎石的使用率分别为40.0%（16/40）和9.5%（4/42）,P＜0.05；EST组术后并发症10例(术后胰腺炎7例，术后出血2例、胆管炎1例)，SEST+EPLBD组术后胰腺炎3例，无出血，胆管炎发生，两组无穿孔、死亡病例，总并发症发生率分别25.0%和2.3%,P＜0.05，差异有统汁学意义。结论 乳头括约肌小切开联合大气囊扩张治疗胆总管较大结石是有效的，相比EST更安全，值得临床推广应用。 　　关键词：胆总管结石；十二指肠憩室；乳头括约肌切开术；气囊扩张术 　　［中图分类号］ R573 ［文献标志码］A 　　Endoscopic sphincterotomy plus large-diameter balloon for removal of lager bile duct stones combined juxtapapillary diverticulum 　　Liu Qunqing，Yang Wenbin，Lin Yuan，Tian Zan ，Zhu Xi， Liu Wen 　　Department of Gastroenterology,Xiangtan Central Hospital, Xiangtan 411100,China 　　Abstract: 【Objective】To investigate the safety and efficiency of endoscopic sphincterotomy plus large-diameter balloon for removal of lager bile duct stones combined juxtapapillary diverticulum. 【Methods】Patients with common bile duct stones(diameterge; 10mm) from February 2011 to April 2015were randomly divided into two groups to receive maximal sphincterotomy(EST group) or endoscopic sphincterotomy plus large-diameter balloon dilation (SEST+EPLBD group),respectively. the success rate of complete stone removal,the rate of using mechanical lithotripsy and related complications were campared between the two groups.【Results】40 patients in EST group and 42 patients in SEST+EPLBD group, the total success rate of stone removal were 95% ( 38/40 ) and 97.6% ( 41/42 ), respectively.the total success rate of complete stone removal between two groups without statistical significance P gt; 0.05, the first success rate of complete stone removal were 65% ( 26/40 ) and 90.4% ( 38/