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投稿时间：2019-02-12 网络发布日期：2019-06-20
投稿时间：2019-02-12 网络发布日期：2019-06-20
中文摘要: 目的 评价内镜下乳头括约肌小切开联合柱状气囊扩张术(ESBD)治疗高龄高危胆总管结石的临床有效性及安全性。方法 将2015年1月至 2018年6月马鞍山市人民医院消化内科收治的58例具有ERCP高危风险因素的高龄(年龄≥80岁)胆总管患者纳入试验组,选取同期住院的具有ERCP高危风险因素的低龄(年龄<80岁)胆总管患者58例作为对照组,两组均采取内镜下乳头括约肌小切开联合柱状气囊扩张术进行ERCP取石治疗。记录观察其临床疗效（完全取石成功率、手术时间、住院时间）、手术并发症（不良事件、消化道出血、穿孔、胰腺炎）；随访6个月结果（健康状况、胆管炎、结石复发）。结果 (1) 两组完全取石成功率及手术时间相似,差异无统计学意义(P>0.05)；但试验组住院时间较对照组有所延长,差异有统计学意义(P<0.05)。(2)试验组与对照组消化道出血发生率分别为12.1%、8.6%,术后胰腺炎发生率是8.2%、11.1%,两组差异均无统计学意义(P>0.05)。试验组术中、术后发生心律失常、心衰、低氧血症不良事件10例,经对症治疗后缓解；对照组仅发生2例相关不良事件,差异有统计学意义(P<0.05)。(3)所有患者出院后全部随访6个月,随访期间均健康生存；试验组胆管炎复发率为10.3%，高于对照组的6.8%,但差异无统计学意义(P>0.05)；两组均未出现胆总管结石复发。结论 临床运用ESBD取石治疗高龄高危胆总管结石安全、有效,可作为一种临床治疗手段的选择。
中文关键词: 内镜下乳头括约肌小切开 柱状气囊扩张术 高龄 高危 胆总管结石
Abstract:ObjectiveTo evaluate the clinical efficacy and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) in the treatment of senile and high-risk choledocholithiasis. Methods A total of 116 patients with high risk of endoscopic retrograde cholangiopancreatography (ERCP) who received treatment from January 2015 to June 2018 were selected and divided into experiment group (n=58) and control group (n=58) according to whether they were over 80 years old or not.ESBD was performed for ERCP in both groups.The clinical efficacy (success rate of complete stone removal,operation time,hospitalization time),operative complications (adverse events,gastrointestinal bleeding,perforation,pancreatitis) and the follow-up results of 6 months after operation (health status,cholangitis,stone recovery) were recorded and observed. Results There was no significant difference in the success rate and operation time between the two groups (P>0.05),but the hospitalization time of the experimental group was significantly longer than that of the control group (P<0.05).There was no significant difference in the incidence of gastrointestinal bleeding (12.1% vs 8.6%,P>0.05) and post-operative pancreatitis (8.2% vs 11.1%,P>0.05) between the experiment group and control group.There were 10 cases of adverse events of arrhythmia,heart failure and hypoxemia during and after operation in the experimental group,which were alleviated after symptomatic treatment.There were only 2 cases of related adverse events in the control group.There was significant difference in the incidence of adverse events between the two groups (P<0.05).All patients were followed up for 6 months after discharge,and all survived well during the follow-up period.The recurrence rate of cholangitis in the experimental group was little higher than that in the control group (10.3% vs 6.8%,P>0.05);there was no recurrence of common bile duct stones in the two groups. Conclusion ESBD is safe and effective in the treatment of elderly and high-risk common bile duct stones,and could be used as a choice of clinical treatment.
keywords: Limited endoscopic sphincterotomy Balloon dilatation Elderly High-risk Choledocholithiasis
文章编号： 中图分类号： 文献标志码：A
基金项目:安徽省科技攻关计划项目(1301zc04070)
| Author Name | Affiliation |
| WANG Kuang-jing,SHEN Lin,FANG Qing-liu,ZHANG Yan,HUANG Jin,SHEN Ying-zhou | Department of Gastroenterology,Maanshan People′s Hospital,Maanshan,Anhui 243000,China |
引用文本：
王旷靖,沈琳,方青骝,张燕,黄锦,沈颖洲.内镜下乳头括约肌小切开联合柱状气囊扩张术治疗高龄高危胆总管结石[J].中国临床研究,2019,32(6):755-758.
王旷靖,沈琳,方青骝,张燕,黄锦,沈颖洲.内镜下乳头括约肌小切开联合柱状气囊扩张术治疗高龄高危胆总管结石[J].中国临床研究,2019,32(6):755-758.