两种内镜下术式治疗胆总管结石的临床效果与安全性比较

目的比较两种内镜下术式治疗胆总管结石的临床效果与安全性。 方法对2015年3月至2017年5月90例胆总管结石患者进行前瞻性对照研究，使用随机数字表法将其分为A组、B组，各45例，A组接受内镜下十二指肠乳头括约肌切开术(EST)联合腹腔镜下胆囊切开术(LC)治疗，B组接受经皮经胆囊十二指肠乳头肌球囊扩张排石术治疗。数据采用SPSS 22.0进行分析，术中术后指标及实验室指标以( ±s)表示，并采用独立t检验；临床预后及术后并发症采用χ²检验，以P<0.05为差异有统计学意义。 结果B组术后近期急性胰腺炎发生率及远期结石复发率低于A组(P<0.05)。两组患者术后1周、术后1个月CA19－9、总胆红素、直接胆红素、ALT、AST均较术前降低，术后1周B组上述指标低于A组(P<0.05)。 结论两种内镜下术式治疗胆总管结石的临床效果相当，经皮经胆囊十二指肠乳头肌球囊扩张排石术的安全性更为理想，值得推荐。

Comparison of the clinical efficacy and safety of two endoscopic surgery for choledocholithiasis

ObjectiveTo compare the clinical efficacy and safety of two endoscopy in the treatment of choledocholithiasis. MethodsA prospective controlled study of 90 patients with choledocholithiasis from March 2015 to May 2017 was conducted. The patients were divided into A group and group B, 45 cases in each group. Patients in A group received endoscopic sphincterotomy (EST) combined with laparoscopic cholecystotomy (LC), while patients in B group received percutaneous balloon dilatation of the cholecystocal papillary muscle and stone drainage treatment. The operation and recovery time, and clinical prognosis and laboratory indexes of the two groups were compared, and the efficacy and safety of two operative methods were also analyzed. Statistical analysis were performed by using SPSS 22. 0 software. The postoperative index and laboratory index were expressed as ( ±s) and the independent t test was used. The clinical prognosis and postoperative complications were examined by Chi-square test. A P value <0.05 was considered as statistically significant difference. ResultsThe incidence of short-term acute pancreatitis and long-term stone recurrence rate in group B were lower than those in group A (P<0.05). The CA19-9, total bilirubin, direct bilirubin, ALT and AST were lower in the two groups after 1 weeks and 1 months after operation. The above indexes in group B were lower than those in the A group at 1 weeks after operation (P<0.05). ConclusionThe clinical outcome of two endoscopy in the treatment of choledocholithiasis is quite effective. The safety of percutaneous balloon dilatation of the cholecystoduodenal papillary muscle and stone drainage treatment is more ideal, which is worthy of clinical recommendation.