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期刊名称:中华消化病与影像杂志
              (电子版)
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经皮胆管置管乳头扩张与内镜乳头切开治疗胆总管结石的临床比较 [中文引用][英文引用]

Clinic comparison of percutaneous transhepatic papillary balloon dilatation with endoscopic sphincterotomy for clearance of common bile duct calculi

作者:孙运福 王理华 
作者(英文): 
单位(英文): 
分类号:
出版年·卷·期(页码):2016·6·第5期(205-209)
DOI: 10.3877/cma.j.issn.2095-2015.2016.05.004
-----摘要:-------------------------------------------------------------------------------------------

目的 比较经皮顺行性球囊扩张乳头括约肌并将胆总管结石推入十二指肠与内镜乳头切开取石的临床效果。方法 回顾性分析2010年3月至2014年5月威海市立医院肝胆外科就诊的71例胆总管结石患者,根据手术方式不同分为顺行乳头扩张组(APBD)35例及内镜乳头切开组(EST)36例。APBD组采用经皮穿肝胆管造影并置管球囊扩张乳头并推出结石。比较两组患者:术前既往胃空肠吻合术后出现率、结石数量及大小、血清直接胆红素、胆总管直径、胆囊储存排空功能指标;术中结石彻底清除率;术后血液检查指标、近期并发症(胰腺炎、胆管炎、胆管出血)发生率及术后2年随访胆囊储存排出功能、胆管结石复发、胆管炎症、胆囊结石、胆管积气发生率。结果 术前既往胃空肠吻合术后出现率、术前胆总管直径及血清直接胆红素APBD组高于EST组[37.1% vs. 5.6%,(14.9±7.4)mm vs. (11.1±6.5)mm,(31.4±9.5)μmol/L  vs. (26.4±7.8)μmol/L];差异均有统计学意义(P<0.05)。APBD组与EST组术中彻底清除胆总管结石成功率及术后近期并发症总发生率比较(91.4% vs. 91.7%, 8.6% vs. 11.1%),差异均无统计学意义(P>0.05)。术后随访2年APBD组与EST组胆总管结石复发率(12.5% vs. 33.3%)、胆管积气发生率(25% vs. 71.9%)、空腹胆囊容积[(21.3±3.3)ml vs(12.1±2.3)ml]、餐后胆囊排出量[(9.9±2.3)mm vs. (6.5±1.9)mm]、急性胆管炎症发生率(15.6% vs. 36.3%)比较,差异均有统计学意义(P<0.05)。APBD组胆囊结石发生率(15.6%)低于EST组(18.1%),差异均无统计学意义(P>0.05)。结论 经皮经胆管扩张乳头括约肌清除胆总管结石与内镜乳头切除取石近期疗效类似,前者在保存Oddi括约肌及胆囊功能、减少术后胆总管结石复发方面具有优势

-----英文摘要:---------------------------------------------------------------------------------------

 Objective To compare the clinical effect of percutaneous transhepatic papilla balloon dilation and endoscopic sphincterotomy for clearance of common bile duct (CBD) calculi into duodenum. Methods March 2010 to May 2014, 71 patients with choledocholithiasis in the department of hepatobiliary surgery of Weihai Municipal Hospital were analyzed retrospectively, of which 35 cases were assigned into antegrade papillary balloon dilation (APBD) group, whereas 36 cases into endoscopic sphincterotomy (EST) group on the basis of surgical modality. The technique of balloon dilation of the papilla and the use of occlusion balloon for clearance of CBD calculi via percutaneous transhepatic cholangiography and cannulation were employed in APBD group. Such variables as previous gastrojejunostomy rate, the number and size of calculi, serum direct bilirubin level, diameter of CBD, filling and emptying function of gallbladder; complete clearance rate of CBD calculi, postoperative blood test value, occurrence rate of short-term complications including acute pancreatitis, cholangitis and hemobilia; filling and emptying function of gallbladder, occurrence rates of recurrent CBD calculi, cholangitis, gallbladder calculi and pneumobilia two years after surgery were compared between the two groups. Results Rate of previous gastrojejunostomy, diameter of CBD, serum direct bilirubin level in APBD group were bigger significantly than those in EST group (37.1% vs. 5.6%, P<0.05; (14.9±7.4)mm vs. (11.1±6.5)mm, P<0.05; (31.4±9.5)μmol/L vs. (26.4±7.8)μmol/L, P<0.05). There was no significantly difference in complete clearance rate of CBD calculi and short-term complications rate between APBD group and EST group (91.4% vs. 91.7%, P>0.05; 8.6% vs. 11.1%, P>0.05). Significant differences were observed by a follow-up of 24 months in pneumobilia rate, rate of recurrent CBD calculi, fasting gallbladder volume, volume of bile discharged after a meal, cholangitis rate between APBD group and EST group (25% vs. 71.9%, P<0.05; 12.5% vs. 33.3%, P<0.05; (21.3±3.3)ml vs. (12.1±2.3)ml, P<0.05; (9.9±2.3)mm vs. (6.5±1.9)mm, P<0.05; 15.6% vs. 36.3%, P<0.05). There was no significant difference in gallbladder calculi rate between APBD group and EST group (15.6% vs. 18.1%, P>0.05). Conclusion APBD is as safety and effective as EST for removal of CBD calculi. The technique of APBD has the advantage in preserving the function of Oddi sphincter and gallbladder as well as diminishing postoperative recurrent rate of CBD calculi.

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中文著录格式: 孙运福,王理华.经皮胆管置管乳头扩张与内镜乳头切开治疗胆总管结石的临床比较.中华消化病与影像杂志(电子版).2016;6(5):205-209.
英文著录格式: .Clinic comparison of percutaneous transhepatic papillary balloon dilatation with endoscopic sphincterotomy for clearance of common bile duct calculi.No Title Settings.2016;6(5):205-209.

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