CAJ | 학술논문

目的探讨内镜下使用不同大小气囊的十二指肠乳头扩张术(EPBD)治疗胆总管结石的近远期效果.方法将连续收治的485例胆总管结石患者结石最大直径划分为:(1)≤6 mm;(2) ＞6～8 mm;(3) ＞8～10 mm;(4) ＞10～12mm;(5) ＞12 mm.分别对应给予单纯小切口(经内镜下乳头括约肌切开)及小切口联合8 mm、10 mm、12 mm、14 mm气囊扩张,相应将胆总管结石患者分为5组,单纯小切口组及小切口联合8 mm组、10 mm组、12 mm组、14 mm组.然后采用取石网篮、取石球囊取石,必要时机械碎石,分析比较不同组之间的近远期效果.结果取石成功率为100％,无死亡病例,无肠穿孔发生.23例(4.74％)有逆行性胆管造影(ERC)术后急性胰腺炎,8例(1.65％)患者术后有上消化道出血.单纯小切口组及小切口联合8 mm组、10 mm组、12 mm组、14 mm组ERC术后急性胰腺炎发生率分别为3.1％ (3/98)、4.9％ (4/81)、3.5％(7/203)、8.9％ (6/67)、8.3％(3/36) (P =0.285),各组术后上消化道出血发生率分别为3.1％ (3/98)、0(0/81)、0.5％(1/203)、3.0％ (2/67)、5.5％ (2/36) (P =0.080),各组之间的近期并发症发生率比较差异无统计学意义.各组之间远期随访胆道积气的发生率分别为2.0％(2/98)、4.9％ (4/81)、8.4％(17/203)、14.9％(10/67)、52.8％ (19/36),差异有统计学意义(P＜0.001),随扩张气囊的直径增加而增高.结论根据胆总管结石大小选择适当大小气囊EPBD联合小切口治疗胆总管结石安全、有效,但随着气囊直径的增加,Oddi括约肌功能损害可能更大.
목적 탐토내경하사용불동대소기낭적십이지장유두확장술(EPBD)치료담총관결석적근원기효과.방법 장련속수치적485례담총관결석환자결석최대직경화분위:(1)≤6 mm;(2) ＞6～8 mm;(3) ＞8～10 mm;(4) ＞10～12mm;(5) ＞12 mm.분별대응급여단순소절구(경내경하유두괄약기절개)급소절구연합8 mm、10 mm、12 mm、14 mm기낭확장,상응장담총관결석환자분위5조,단순소절구조급소절구연합8 mm조、10 mm조、12 mm조、14 mm조.연후채용취석망람、취석구낭취석,필요시궤계쇄석,분석비교불동조지간적근원기효과.결과 취석성공솔위100％,무사망병례,무장천공발생.23례(4.74％)유역행성담관조영(ERC)술후급성이선염,8례(1.65％)환자술후유상소화도출혈.단순소절구조급소절구연합8 mm조、10 mm조、12 mm조、14 mm조ERC술후급성이선염발생솔분별위3.1％ (3/98)、4.9％ (4/81)、3.5％(7/203)、8.9％ (6/67)、8.3％(3/36) (P =0.285),각조술후상소화도출혈발생솔분별위3.1％ (3/98)、0(0/81)、0.5％(1/203)、3.0％ (2/67)、5.5％ (2/36) (P =0.080),각조지간적근기병발증발생솔비교차이무통계학의의.각조지간원기수방담도적기적발생솔분별위2.0％(2/98)、4.9％ (4/81)、8.4％(17/203)、14.9％(10/67)、52.8％ (19/36),차이유통계학의의(P＜0.001),수확장기낭적직경증가이증고.결론 근거담총관결석대소선택괄당대소기낭EPBD연합소절구치료담총관결석안전、유효,단수착기낭직경적증가,Oddi괄약기공능손해가능경대.
Objective To assess the short and long term outcomes of endoscopic papillary balloon dilation (EPBD) with different sized balloon for removal of common bile duct (CBD) stones.Methods A total of 485 consecutive patients were enrolled, who were divided into five groups based on the largest CBD stone size, i.e.group 1 ≤6 mm, group 2 ＞6-8 mm, group 3 ＞8-10 mm, group4 ＞ 10-12 mm,and group 5 ＞ 12 mm.Patients in each group underwent limited endoscopic sphincterotomy (EST) alone, or limited EST followed by EPBD with 8 mm, 10 mm, 12 mm, or 14 mm balloons, respectively.CBD stones were removed with retrieval balloon, Dormia basket, and/or mechanical lithotripsy if necessary.The short and long term outcomes were compared among these five groups.Results The overall success rates of stone removal in all groups were 100％, and no perforation or death occurred.Twenty-three (4.74％) patients had postERC pancreatitis, and 8 (1.65％) had post-operative bleeding.The incidences of post-ERC acute pancreatitis of each group were 3.1％ (3/98), 4.9％ (4/81), 3.5 ％ (7/203), 8.9％ (6/67), 8.3 ％ (3/36), respectively (P =0.285).The incidences of bleeding in each group were 3.1％ (3/98), 0 (0/81), 0.5 ％ (1/203), 3.0％ (2/67)and 5.5％ (2/36), respectively(P =0.080).There was no significant differences in early complication rates among the five groups.The incidences of pneumobilia of each group were 2.0％ (2/98), 4.9％ (4/81), 8.4％ (17/203), 14.9％ (10/67) and 52.8％ (19/36), respectively (P ＜ 0.001).The incidence of pneumobilia increased with the size of the balloon.Conclusion Choice of a balloon size based on the largest CBD stone diameter is safe and effective for removing CBD stones, but with the increase of balloon size, Oddi function may be damaged more severely.