内镜下乳头括约肌小切开术联合球囊扩张术治疗非扩张性肝外胆管结石患者疗效再研究

doi:10.3969/j.issn.1672-5069.2021.01.035

Abstract

Abstract: Objective The purpose of this study was to investigate the combination of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in treatment of patients with non-expansive extrahepatic bile duct stones. Methods The clinical data of 120 patients with non-expansive extrahepatic bile duct stones were admitted to the Department of Hepatobiliary Surgery in our hospital between July 2017 and May 2019, and were randomly divided into control (n=60) and observation group (n=60), underwent EST or EST and EPBD combination surgery. Results 7 days after the operation, the white blood cell (WBC) counts in the observation group was (7.8±1.4) ×10⁹/L, not statistically significantly different as compared to (7.6±1.2) ×10⁹/L in the control (P>0.05), serum cyclooxygenase-2 level in the observation group was (45.3±11.7) ng/mL, not much different to (49.6±15.2) ng/mL, blood procalcitonin (PCT) level was (0.4±0.3) g/L, not significantly different to (0.4±0.2) g/L, serum C-reactive protein (CRP) level was (8.7±2.9) mg/L, not significantly different to (8.4±3.2) mg/L, serum tumor necrosis factor-α (TNF-α) level was (0.5±0.2) ng/mL, not significantly different to (0.5±0.2) ng/mL, blood amylase level was (60.1±16.7) U/L, not significantly different to (58.7±15.3) U/L in the control (P>0.05); the total incidence of complications in the observation group was 25.0%, not statistically significantly different compared with 31.7% (P>0.05) in the control; the successful rate of primary stone removal in the observation group was 98.3%, significantly higher than 86.7% in the control, and the mechanical gravel rate was 5.0% and the stone recurrence rate was 3.3%, both significantly lower than 16.7% and 15.0%, respectively, (P<0.05) in the EST-treated patients.Conclusion The combination of EST and EPBD in the treatment of patients with non-dilated extrahepatic bile duct stones has a higher successful rate of one-step stone extraction, with less postoperative stone recurrence, which warrants further clinical investigation.

Key words: Cholelithiasis, Endoscopic sphincterotomy, Endoscopic papillary balloon dilation, Therapy, Recurrence

Zhang Bo, Huang Lei, Huang Xia. Combination ofendoscopic sphincterotomy and endoscopic papillary balloon dilation intreatment of patients with non-expansive extrahepatic bile duct stones[J]. Journal of Practical Hepatology, 2021, 24(1): 135-138.

References

[1] Xu Y, Dong C, Ma K, et al.Spontaneously removed biliary stent drainage versus T-tube drainage after laparoscopic common bile duct exploration. Medicine, 2016, 95(39): e5011.
[2] 李华林, 陈安平, 胡铤, 等. 腹腔镜胆总管探查鼻胆管引流与 T管引流的疗效比较. 中国内镜杂志, 2016, 22(5): 12-16.
[3] Chiang PH, Lai KH, Tsai TJ, et al. Is endoscopic treatment beneficial in patients with clinically suspicious of common bile duct stones but no obvious filling defects during the ERCP examination. BMC Gastroenterol, 2016, 16(1): 102.
[4] Gurusamy K, Davidson C, Gluud C, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Pol Przegl Chir, 2017, 67(5):381-387.
[5] 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2011年版). 中华消化外科杂志, 2011, 10(1): 9-13.
[6] 鲁力锋, 王拥军, 张澍田. 十二指肠乳头括约肌小切开联合大球囊扩张治疗胆总管结石术后远期复发情况的研究. 中华消化内镜杂志, 2016, 33(11): 756-758.
[7] 潘文君, 孙明军, 闫国强. EST术联合EPBD术治疗非扩张性肝外胆管结石患者临床研究.实用肝脏病杂志, 2019, 22(1): 141-144.
[8] Nzenza TC, Alhabbal Y, Guerra GR, et al. Recurrent commonbile duct stones as a late complication of endoscopic sphincterotomy. BMC Gastroenterol, 2018, 18(1): 39.
[9] Zhou X D, Chen Q F, Zhang Y Y, et al. Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones. World J Gastroenterol, 2019, 25(4): 485-497.
[10] Shen Y H, Yang L Q, Yao Y L, et al. Dilation time in endoscopic papillary balloon dilation for common bile duct stones. Urg Laparo Endo Per, 2017, 27(5): 351.
[11] Park J S, Jeong S, Bang B W, et al. Endoscopic papillary large balloon dilatation without sphincterotomy for the treatment of large common bile duct stone: long-term outcomes at a single center. Dig Dis Sci, 2016, 61(10): 3045-3053.
[12] Nakeeb A E, Ezzet H, Askar W, et al. Early versus late cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography: a prospective randomized study. Surg Laparo Endo Per, 2016, 26(3): 125-127.
[13] Fujita Y, Iwasaki A, Sato T, et al. Feasibility of endoscopic papillary large balloon dilation in patients with difficult bile duct stones without dilatation of the lower part of the extrahepatic bile duct. Gut Liver, 2016, 11(1): 67-69.
[14] Korrapati P, Ciolino J, Wani S, et al. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis. Endosc Int Open, 2016, 04(3): 263-275.
[15] Kuo YT, Wang HP, Chang CY, et al. Comparable long-term outcomes of 1-minute vs 5-minute endoscopic papillary balloon dilation for bile duct stones. Gastrointest Endosc, 2016, 83(5): 618-619.
[16] Tringali A, Sica M, Manta R, et al. Oc.10.6 post-sphincterotomy transpapillary balloon dilation for removal of large bile duct stone is more effective and safe compared to endoscopic sphincterotomya meta-analysis. Dig Liver Dis, 2016, 48(2): 109.
[17] Chong CC, Chiu PW, Tan T, et al. Correlation of cbd/chd angulation with recurrent cholangitis in patients treated with ERCP. Endoscopy, 2016, 4(1): 62-67.
[18] Zhu K, Wang JP, Su JG. Comparison of intraoperative conditions and postoperative inflammatory response and immune response between patients with common bile duct stones undergoing ESBD and EST.J Hum Med, 2016, 22(16): 56-59.
[19] He YF. Efficacy and safety of minor endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in treatment of elderly patients with multiple large common bile duct stones. J Hepatol, 2018, 3(8): 25-28.
[20] Shim CS, Kim JW, Lee TY, et al. Is endoscopic papillary large balloon dilation safe for treating large cbd stones? Saudi J Gastroenterol, 2016, 22(4): 251.
[21] Kato S, Chinen K, Shinoura S, et al. Predictors for bile duct stone recurrence after endoscopic extraction for nave major duodenal papilla: a cohort study. Plos One, 2017, 12(7): 180536.

Combination ofendoscopic sphincterotomy and endoscopic papillary balloon dilation intreatment of patients with non-expansive extrahepatic bile duct stones

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