Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHENG Guilong , DING Haihua , DING Zhiqing , DENG Xianren

Department of General Surgery, The Second People’s Hospital of Zhenjiang City, Zhenjiang, Jiangsu 212002, P.R.China;

Corresponding?author：

ZHENG Guilong, Email: zhengguilong@sohu.com

Keywords：

endoscopic sphincterotomy with small incision; endoscopic papillary balloon dilation; conventional endoscopic sphincterotomy; common bile duct stone

DOI：

10.7507/1007-9424.201607002

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.

Citation： ZHENG Guilong, DING Haihua, DING Zhiqing, DENG Xianren. Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 474-477. doi: 10.7507/1007-9424.201607002 Copy

1.	?莊文龍. 內鏡下乳頭括約肌切開術 (EST) 與內鏡下乳頭球囊擴張 (EPBD) 治療老年膽總管結石患者的臨床分析. 吉林大學, 2013.
2.	姜海行, 唐國都, 黃杰安, 等. 內鏡下乳頭括約肌切開術與球囊擴張術治療膽總管結石的臨床對照研究. 沈陽: 第七屆全國 ERCP 學術研討會暨 2014 膽胰疾病內鏡診療新技術論壇大會, 2014.
3.	滕曉生, 李青松. 內鏡下十二指腸乳頭小切開聯合乳頭球囊擴張術治療膽總管較大結石臨床觀察. 中華老年醫學雜志, 2015, 34(3): 287-289.
4.	楊建鋒, 王霞, 王暉, 等. 十二指腸乳頭括約肌切開術對 Oddi 括約肌功能的影響及與遠期并發癥的關系. 中華消化內鏡雜志, 2014, 31(1): 5-8.
5.	李俊景, 畢淑娟, 趙丹瑜, 等. 乳頭括約肌切開術聯合內鏡下逆行胰膽管造影術內鏡下治療膽總管較大結石的護理配合. 中國藥物與臨床, 2015, 15(10): 1522-1523.
6.	趙昌杰, 陳林. 經內鏡乳頭括約肌小切開聯合柱狀球囊擴張術治療膽總管結石 36 例分析. 中國臨床研究, 2016, 29(1): 81-83.
7.	周春曉. 內鏡下乳頭肌小切開聯合球囊擴張治療老年膽總管結石的療效分析. 肝膽外科雜志, 2015, 23(6): 409-412.
8.	黃永德, 何謙, 張誠華, 等. 內鏡下 sEST + EPBD 治療合并乳頭旁憩室的膽總管結石臨床分析. 現代中西醫結合雜志, 2014, 23(18): 2008-2010.
9.	馮明明, 孫萬日, 王慶元, 等. EST 治療伴或不伴有膽石癥的 Oddi 括約肌乳頭狹窄. 中國普通外科雜志, 2014, 23(2): 250-253.
10.	何芳, 張光全, 李靜. 兩種膽總管結石手術的臨床療效比較. 胃腸病學和肝病學雜志, 2014, 23(8): 934-936.
11.	凌峰. 乳頭括約肌小切口聯合球囊擴張治療膽總管結石的療效及安全性. 現代消化及介入診療, 2014, 19(6): 388-389.
12.	王毓彬, 陳雙東. EST + EPBD 治療膽總管結石的效果分析. 肝膽外科雜志, 2014, 22(3): 210-213.
13.	Kim KH, Rhu JH, Kim TN. Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy: long-term follow-up study. Gut Liver, 2012, 6(1): 107-112.
14.	Guo SB, Meng H, Duan ZJ,et al. Small sphincterotomy combined with endoscopic papillary large balloon dilationvs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol, 2014, 20(47): 17962-17969.
15.	潘俊, 董衛國, 劉敏, 等. ERCP 中 SEST 聯合 EPBD 對比單純 EST 對膽總管結石取石的臨床分析. 胃腸病學和肝病學雜志, 2015, 24(3): 341-343.
16.	Ishii K, Itoi T, Itokawa F,et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis caused by papillary large-balloon dilation of incidental intrapapillary fistula in Roux-en-Y patients: lesson from a case. Dig Endosc, 2014, 26 Suppl 2: 144-146.
17.	張莉, 吳瑜, 秦鳴放. 膽總管下端良性狹窄患者內鏡下十二指腸乳頭括約肌切開術前后 Oddi 括約肌壓力變化的分析. 中國內鏡雜志, 2014, 20(11): 1165-1167.
18.	張節, 李能平, 張亞運, 等. 內鏡下不同大小氣囊擴張十二指腸乳頭治療膽總管結石近遠期效果的研究. 中華消化內鏡雜志, 2015, 32(8): 534-539.
19.	朱玲玲, 張健康. EST 小切開聯合 EPBD 治療膽總管結石合并乳頭旁憩室的臨床分析. 中國醫學創新, 2016, 13(4): 46-49.
20.	Trikudanathan G, Arain MA, Attam R,et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 535-544.
21.	Kataoka K, Aoyama I, Mizusawa J,et al. A randomized controlled phase Ⅱ/Ⅲ study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol, 2015, 45(4): 385-389.
22.	Veitch AM, Vanbiervliet G, Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut, 2016, 65(3): 374-389.
23.	張楷, 詹峰, 張云, 等. 腹腔鏡再次膽道手術治療膽總管結石. 中華肝膽外科雜志, 2014, 20(4): 265-268.
24.	Lai KH, Chan HH, Tsai TJ,et al. Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones. World J Gastrointest Endosc, 2015, 7(2): 77-86.
25.	周賢斌, 葉麗萍, 張玉, 等. 內鏡下乳頭括約肌小切開聯合球囊擴張術治療肝硬化合并膽總管結石的療效觀察. 中華消化內鏡雜志, 2014, 31(12): 708-712.

1. ?莊文龍. 內鏡下乳頭括約肌切開術 (EST) 與內鏡下乳頭球囊擴張 (EPBD) 治療老年膽總管結石患者的臨床分析. 吉林大學, 2013.
2. 姜海行, 唐國都, 黃杰安, 等. 內鏡下乳頭括約肌切開術與球囊擴張術治療膽總管結石的臨床對照研究. 沈陽: 第七屆全國 ERCP 學術研討會暨 2014 膽胰疾病內鏡診療新技術論壇大會, 2014.
3. 滕曉生, 李青松. 內鏡下十二指腸乳頭小切開聯合乳頭球囊擴張術治療膽總管較大結石臨床觀察. 中華老年醫學雜志, 2015, 34(3): 287-289.
4. 楊建鋒, 王霞, 王暉, 等. 十二指腸乳頭括約肌切開術對 Oddi 括約肌功能的影響及與遠期并發癥的關系. 中華消化內鏡雜志, 2014, 31(1): 5-8.
5. 李俊景, 畢淑娟, 趙丹瑜, 等. 乳頭括約肌切開術聯合內鏡下逆行胰膽管造影術內鏡下治療膽總管較大結石的護理配合. 中國藥物與臨床, 2015, 15(10): 1522-1523.
6. 趙昌杰, 陳林. 經內鏡乳頭括約肌小切開聯合柱狀球囊擴張術治療膽總管結石 36 例分析. 中國臨床研究, 2016, 29(1): 81-83.
7. 周春曉. 內鏡下乳頭肌小切開聯合球囊擴張治療老年膽總管結石的療效分析. 肝膽外科雜志, 2015, 23(6): 409-412.
8. 黃永德, 何謙, 張誠華, 等. 內鏡下 sEST + EPBD 治療合并乳頭旁憩室的膽總管結石臨床分析. 現代中西醫結合雜志, 2014, 23(18): 2008-2010.
9. 馮明明, 孫萬日, 王慶元, 等. EST 治療伴或不伴有膽石癥的 Oddi 括約肌乳頭狹窄. 中國普通外科雜志, 2014, 23(2): 250-253.
10. 何芳, 張光全, 李靜. 兩種膽總管結石手術的臨床療效比較. 胃腸病學和肝病學雜志, 2014, 23(8): 934-936.
11. 凌峰. 乳頭括約肌小切口聯合球囊擴張治療膽總管結石的療效及安全性. 現代消化及介入診療, 2014, 19(6): 388-389.
12. 王毓彬, 陳雙東. EST + EPBD 治療膽總管結石的效果分析. 肝膽外科雜志, 2014, 22(3): 210-213.
13. Kim KH, Rhu JH, Kim TN. Recurrence of bile duct stones after endoscopic papillary large balloon dilation combined with limited sphincterotomy: long-term follow-up study. Gut Liver, 2012, 6(1): 107-112.
14. Guo SB, Meng H, Duan ZJ,et al. Small sphincterotomy combined with endoscopic papillary large balloon dilationvs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol, 2014, 20(47): 17962-17969.
15. 潘俊, 董衛國, 劉敏, 等. ERCP 中 SEST 聯合 EPBD 對比單純 EST 對膽總管結石取石的臨床分析. 胃腸病學和肝病學雜志, 2015, 24(3): 341-343.
16. Ishii K, Itoi T, Itokawa F,et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis caused by papillary large-balloon dilation of incidental intrapapillary fistula in Roux-en-Y patients: lesson from a case. Dig Endosc, 2014, 26 Suppl 2: 144-146.
17. 張莉, 吳瑜, 秦鳴放. 膽總管下端良性狹窄患者內鏡下十二指腸乳頭括約肌切開術前后 Oddi 括約肌壓力變化的分析. 中國內鏡雜志, 2014, 20(11): 1165-1167.
18. 張節, 李能平, 張亞運, 等. 內鏡下不同大小氣囊擴張十二指腸乳頭治療膽總管結石近遠期效果的研究. 中華消化內鏡雜志, 2015, 32(8): 534-539.
19. 朱玲玲, 張健康. EST 小切開聯合 EPBD 治療膽總管結石合并乳頭旁憩室的臨床分析. 中國醫學創新, 2016, 13(4): 46-49.
20. Trikudanathan G, Arain MA, Attam R,et al. Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 535-544.
21. Kataoka K, Aoyama I, Mizusawa J,et al. A randomized controlled phase Ⅱ/Ⅲ study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol, 2015, 45(4): 385-389.
22. Veitch AM, Vanbiervliet G, Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut, 2016, 65(3): 374-389.
23. 張楷, 詹峰, 張云, 等. 腹腔鏡再次膽道手術治療膽總管結石. 中華肝膽外科雜志, 2014, 20(4): 265-268.
24. Lai KH, Chan HH, Tsai TJ,et al. Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones. World J Gastrointest Endosc, 2015, 7(2): 77-86.
25. 周賢斌, 葉麗萍, 張玉, 等. 內鏡下乳頭括約肌小切開聯合球囊擴張術治療肝硬化合并膽總管結石的療效觀察. 中華消化內鏡雜志, 2014, 31(12): 708-712.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficacy of endoscopic sphincterotomy with small incision combined with endoscopic papillary balloon dilation in treatment of larger common bile duct stones

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