周春晓　张金坤　杨柳

[摘要] 目的 探讨内镜下乳头小切开联合球囊扩张治疗老年胆总管结石的临床效果及患者预后。 方法 随机选取2012年7月—2014年6月期间在该院接受治疗的老年胆总管结石患者90例，将患者按照治疗方法的差异分为大切口乳头括约肌组（EST）；内镜下球囊扩张术组（EPBD）及内镜下乳头小切开联合球囊扩张术组（SES联合EPBD），每组各30例。比较3组患者的治疗效果及预后。 结果 3组患者均顺利完成手术，EST、EPBD及联合组的并发症发生率为10%、26.7%和6.7%；复发率分别为20%、10%和3.3%。均以SES联合EPBD组最低。 结论 内镜下乳头小切开联合球囊扩张治疗老年胆总管结石疗效显著，预后较好，可在临床上进行广泛推广使用。

[关键词] 内镜下；乳头小切开；球囊扩张；胆总管结石；疗效

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2015）12（a）-0052-02

[Abstract] Objective To study the clinical effect and prognosis of endoscopic sphincteropapillotomy combined with balloon dilatation in treatment of elderly patients with choledocholithiasis. Methods 90 elderly patients with choledocholithiasis treated in our hospital from July 2012 to June 2014 were selected and divided into large incision sphincterotomy group（EST）， endoscopic balloon dilation group（EPBD） and endoscopic sphincteropapillotomy combined with balloon dilatation group（SES combined with EPBD） with 30 cases in each. The treatment effects and prognosis of the three groups were compared. Results The surgery was successfully performed in the three groups. The incidence of complications in the EST group， EPBD group and SES combined with EPBD group was respectively 10%， 26.7% and 6.7%， the SES combined with EPBD group had the lowest incidence of complications. The recurrence rate in the EST group， EPBD group and SES combined with EPBD group was respectively 20%， 10% and 3.3%， the SES combined with EPBD group had the lowest recurrence rate. Conclusion Endoscopic sphincteropapillotomy combined with balloon dilatation in treatment of elderly patients with choledocholithiasis has an obvious curative effect and better prognosis， which can be widely promoted and applied in clinic.

[Key words] Endoscopic； Sphincteropapillotomy； Balloon dilatation； Choledocholithiasis； Curative effect

胆总管结石是临床上的常见病与多发病，而老年患者又是该病的主要发病人群。临床上对该类疾病患者主要以外科手术治疗为主，其中又以内镜下乳头括约肌切开术较为常用[1-2]。在该次调查中，随机选取2012年7月—2014年6月期间在该院接受治疗的老年胆总管结石患者90例作为调查对象，将重点分析内镜下乳头小切开联合球囊扩张治疗老年胆总管结石的临床效果及预后因素，并与传统的大切口乳头括约肌与内镜下球囊扩张术进行观察比较。报道如下。

1 资料与方法

1.1 一般资料

随机选取在该院接受治疗的老年胆总管结石患者90例，将患者按照治疗方法的差异分为EST组、EPBD组与SES联合EPBD组，每组30例。……