CAJ | 학술논문

目的评价胆总管结石乳头括约肌小切开联合气囊扩张术代替乳头括约肌切开术的可行性.方法将2008年5月至2011年4月收治的符合纳入标准的462例胆总管结石患者随机分为两组:乳头括约肌小切开联合大气囊扩张组与乳头括约肌切开组.比较两组一次性结石取净率、总的结石取净率、机械碎石使用率、操作时间、射线照射时间及短期并发症的发生率.结果乳头括约肌小切开联合大气囊扩张更高效.与乳头括约肌切开组相比,乳头括约肌小切开联合大气囊扩张组以更低的机械碎石使用率(12.1％比34.8％,P＜0.05)取得了更高的一次性结石取净率(86.2％比70.4％,P＜0.05),并且操作时间(38.6±15.5) min比(47.1±20.2) min,P＜0.05]与射线曝光时间[(17.3±7.0)min比(26.5±10.8)min,P＜0.05]显著缩短.两组患者总的结石取净率(96.5％比93.5％,P＞0.05)、24 h并发症发生率(6.9％和11.7％,P＞0.05)差异无统计学意义.结论对于胆总管结石,乳头括约肌小切开联合大气囊扩张与乳头括约肌切开同样安全.但乳头括约肌小切开联合大气囊扩张术更加高效,未来有望取代乳头括约肌切开术成为胆总管结石的首选.
목적 평개담총관결석유두괄약기소절개연합기낭확장술대체유두괄약기절개술적가행성.방법 장2008년5월지2011년4월수치적부합납입표준적462례담총관결석환자수궤분위량조:유두괄약기소절개연합대기낭확장조여유두괄약기절개조.비교량조일차성결석취정솔、총적결석취정솔、궤계쇄석사용솔、조작시간、사선조사시간급단기병발증적발생솔.결과 유두괄약기소절개연합대기낭확장경고효.여유두괄약기절개조상비,유두괄약기소절개연합대기낭확장조이경저적궤계쇄석사용솔(12.1％비34.8％,P＜0.05)취득료경고적일차성결석취정솔(86.2％비70.4％,P＜0.05),병차조작시간(38.6±15.5) min비(47.1±20.2) min,P＜0.05]여사선폭광시간[(17.3±7.0)min비(26.5±10.8)min,P＜0.05]현저축단.량조환자총적결석취정솔(96.5％비93.5％,P＞0.05)、24 h병발증발생솔(6.9％화11.7％,P＞0.05)차이무통계학의의.결론 대우담총관결석,유두괄약기소절개연합대기낭확장여유두괄약기절개동양안전.단유두괄약기소절개연합대기낭확장술경가고효,미래유망취대유두괄약기절개술성위담총관결석적수선.
Objective To evaluate whether small endoscopic sphincterotomy (EST) plus balloon dilation (EPBD) can replace endoscopic sphincterotomy (EST) alone for patients with common bile duct (CBD) stones.Methods From May 2008 to April 2011,462 patients with CBD stones were randomly divided into two groups.The success rate of complete stone removal after the first session,the rate of using mechanical lithotripsy (ML),the short-term complications,the procedure time and fluo roscopy time were compared between the two groups.Results Overall ductal clearance did not differ between the two groups (96.5％ vs 93.5％,P＞0.05).The complication rates at 24 hours were 6.9％ for the small EST plus EPBD group and 11.7％ for the EST group (P＞0.05).However,the rate of complete stone removal after the first session using small EST plus EPBD was significantly higher than EST alone (86.2％ vs 70.4％,P＜0.05).ML was required significantly more often in the EST group when compared with the small EST plus EPBD group (34.8％ vs 12.1％,P＜0.05).The total procedure time and total fluoroscopy time in the small EST plus EPBD group were significantly shorter than the EST group [(38.6±15.5) min vs (47.1±20.2) min,P＜0.05 and (17.3± 7.0) min vs (26.5±10.8) min,P＜0.05].Conclusions Compared with EST,small EST plus EPBD was safe and more efficacious for bile duct stones.In the future,small EST plus EPBD probably can replace EST to be the first treatment of choice for bile duct stones.