阮巍山?岑川?林宏凯?刘烨琳

[摘要] 目的 临床分析内镜下乳头括约肌小切开联合大球囊扩张术治疗难治性胆总管结石的效果。 方法 选取2014年10月～2016年8月间我院收治的胆总管结石患者101例，将所选患者按照治疗方法不同分为三组，所有患者在入院收治后均进行内窥镜逆行胰胆管造影术。标准组1采用内镜乳头括约肌切开术EST，标准组2采用内镜乳头柱状球囊扩张术EPBD，實验组采用内镜下乳头括约肌小切开联合大球囊扩张术，即EST+EPBD。治疗结束后，测量记录所有患有的一次取石成功率，统计术后并发症发生率，并将结果使用SPSS19.0软件进行数据处理。 结果 标准组1，即采用内镜乳头括约肌切开术EST的患者，一次取石成功率为54.55%，采用内镜乳头柱状球囊扩张术EPBD的标准组2，一次取石成功率为69.70%，实验组患者的一次取石成功率为97.14%，χ2=16.656，P<0.05。标准组1患者的并发症发病率为36.36%，标准组2患者的并发症发病率为33.33%，实验组患者的并发症发病率为5.71%，χ2=10.504，P<0.05。 结论 采用内镜下乳头括约肌小切开联合大球囊扩张术治疗难治性胆总管结石疗效显著，应在临床中推广使用。

[关键词] 内镜下乳头括约肌小切开术；球囊扩张术；胆总管结石；胰腺炎

[中图分类号] R657.42 [文献标识码] A [文章编号] 2095-0616（2017）07-210-04

Clinical analysis of 101 cases of intractable choledocholithiasis treated by endoscopic sphincterotomy combined with large balloon dilatation

RUAN Weishan CEN Chuan LIN Hongkai LIU Yelin

Department of Gastroenterology， Zhongshan People's Hospital， Guangdong， Zhongshan 528400， China

[Abstract] Objective To clinically analyze the effect of endoscopic sphincterotomy combined with large balloon dilatation in the treatment of intractable choledocholithiasis. Methods 101 patients with choledocholithiasis who were admitted to our hospital from October 2014 to August 2016 were selected. All patients were divided into three groups according to different treatment methods and they were all treated with endoscopic retrograde cholangiopancreatography. The standard group one was used endoscopic sphincterotomy （EST）. The standard group 2 was treated with endoscopic papillary balloon dilatation （EPBD） and the experimental group was used endoscopic sphincterotomy combined with large balloon dilatation （EST + EPBD）. After treatment， the success rate of stone removal for once and postoperative morbidity of all patients were recorded. The results were analyzed by SPSS19.0 software. Results The success rates of stone removal for once in the standard group one， the standard group two and the experimental group were 54.55%， 69.70% and 97.14% respectively， χ2=16.656， P<0.05. Postoperative morbidities of patients in the standard group one， the standard group two and the experimental group were 36.36%， 33.33% and 5.71% respectively， χ2=10.504， P<0.05. Conclusion The effect of endoscopic sphincterotomy combined with large balloon dilatation in the treatment of intractable choledocholithiasis is significant and it is worthy of clinical promotion and application.

[Key words] Endoscopic sphincterotomy；Balloon dilatation；Choledocholithiasis；Pancreatitis

胆总管结石（calculusofcommonbileduct； choledocholith）大部分为胆色素结石，还有以胆色素结石为主的混合性结石，一般发病于胆总管下端[1]。胆总管结石是胆管中的一种常见疾病，发病时会出现腹部绞痛、对穿性背痛、黄疸、高热等，病情严重时会危及患者生命，极大的影响患者的生活质量[2]。为进一步改进治疗效果，本文针对我院收治的101例胆总管结石患者，详细分析了内镜下乳头括约肌小切开联合大球囊扩张术治疗难治性胆总管结石的临床疗效，结果如下。

1 资料与方法