目的 比较内镜下柱状气囊扩张术(EPBD)与EPBD联合十二指肠乳头括约肌小切开术(SEST)治疗胆总管大结石的有效性和安全性.方法 2014年1月-2015年12月该院78例胆总管大结石患者,随机分为EPBD组和EPBD+SEST组,比较两组取石成功率、术后24 h血淀粉酶、术前术后总胆红素(TBL)、转氨酶、碱性磷酸酶(ALP)、内镜逆行胰胆管造影术(ERCP)次数及术后胰腺炎等并发症.结果 两组一次性取石成功率、ERCP取石次数、操作时间及1周后肝酶谱下降水平差异无统计学意义.两组术后并发症如术后高淀粉酶血症、术后胰腺炎和术后出血等并发症差异无统计学意义.结论 EPBD与EPBD+SEST治疗胆总管大结石具有相似的临床效果,其并发症无明显差异,值得临床广泛应用.%Objective To compare the clinical efficacy and safety of endoscopic papillary balloon dilation (EPBD) and endoscopic papillary balloon dilation (EPBD) combined with small endoscopic sphincterotomy (SEST) in treatment of large choledocholithiasis. Methods 78 patients with large choledocholithiasis from January 2014 to December 2015 were randomly divided into EPBD group, and combination treatment group. The level of bilirubin, transaminase, alkaline phosphatase (ALP) before and after the operation, the success rates of stone removal, serum amylase of 24 h after the operation, the operation times of endoscopic retrograde cholangiopancreatography (ERCP) and whether complicated with postoperative pancreatitis were compared between the two groups. Results There was no significant difference of the success rates of stone removal, serum amylase of 24 h after the operation, the operation times of ERCP between the two groups. The level of bilirubin, transaminase, alkaline phosphatase (ALP) was declined after EPBD or EPBD and SEST, and the results of the two groups had no statistical significance (P > 0.05). Also there was no significant difference of the incidence of postoperative pancreatitis, postoperative bleeding and postoperative hyperamylasemia between the two groups (P > 0.05). Conclusion EPBD is worthy of promoting because it has a similar clinical efficacy and safety to EPBD and SEST in treatment of large choledocholithiasis.
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