经内镜乳头括约肌切开术与经内镜乳头气囊扩张术治疗肝外胆管结石的临床比较胡贯中J金震东J刘枫J张敏敏J王东2,王洛伟2,施新岗2,陈洁2,李兆申2,邹多武才1.复旦大学校医院内科，上海200-1332.第二军医大学长海医院消化内科，上海200433［作者简介］胡贯中,硕士生,主治医师.E-mail：huguanzhong8@I63.com*通信作者(Correspondingauthor).Tel:021-31161337,E-mail：duowuzou@smmu.edu.cn［摘要］目的比较经内镜乳头括约肌切开术(EST)与经内镜乳头气骐扩张术(EPBD)在治疗肝外祖管结石方面的并同。方法冋顾性分析上海K海医院消化内科2009年8月至2011年7月277例肝外胆管结石患者的临床资料，其中行EST的168例，行EPBD的109例，分别对EST组和EPBD组的病例基本悄况、结石直径、取石方法、手术时间、结石一次取净率、术后住院日、近期并发症等方面进行比较。结果两组病例在年龄、男女性别比、合并十二指肠憩室方面的差异均无统计学意义；EST组结石直径为(ll.3±6.2)mm,EPBD组结石直径为(10.I±5.7)mm,两者差异无统计学意义(P=0.1056)；EST纽和EPBD&1取石方法之间比较，差异无统让学意义;ESTSIT-术操作时间平均为(21.2±3.1)min,EPBD组手术操作时间平均为(20.7±2.5)min,两者差异无统计学意义(P=0.1591)：EST组结石一次収挣率为95.2%,与EPBD组的94.5%比较，两者差异无统计学意义(P=0.7828)；术后住院日EST组为(4.1+1.9)d；EPBD组为(4.1+2.0)d,两者差异无统计学意义(P=1.0000)；EST组近期并发症总发生率为10.1%,EPBD组为12.8%,两者差并无统计学意义(P=0.4822),EST纽中出血的发生率为3.6%,EPBD纽为0,两者之间的差异具有统计学意义(Pv0.05)：EPBD纽的高淀粉嗨血症的发生率为8.3%,EST31为2.4%,两者之间的差异具有统计学意义(P<0.05).结论EST和EPBD治疗肝外胆管结石各有利弊,对于手术方式的选择,应根据患者的具体恬况而无须局限于结石的大小。［关键词］嗾胆管造影术，内窥镜逆行:括约肌切开术，内窥镜;气魏扩张术：胆总管结石［中图分类号］R575.7ComparisonofendoscopicsphincterotomyandendoscopicpapillaryballoondilationinthetreatmentofextrahepaticbileductstonesHUGuan-zhong1,JINZhen-dong2,LIUFeng2,ZHANGMin-min2,WANGDong2,WANGLuo-wei2,SHIXin-gang2,CHENJie2,LIZhao-shen2,ZOUDuo-wu"I.DepartmentofInternalmedicine,FudanUniversityHospitaLShanghai200433,China2.DepartmentofGastroenterologytChanghaiHospitaLSecondMilitaryMedicalUniversity,Shanghai200433,China［Abstract］ObjectiveTocompareendoscopicsphincterotomy(EST)andendoscopicpapillaryballoondilation(EPBD)inthetreatmentofextrahepaticbileductstonesintermsofsimilaritiesanddifferences・MethodsClinicaldataof277patientswithextrahepaticbileductstonesfromAugust2009toJuly2011ingastroenterologydepartmentofShanghaiChanghaiHospitalwereretrospectivelyanalyzed・168ofthe277patientsreceivedESTandtheother109receivedEPBD.Thegeneralcase,stonediameter,stoneextractionmethod,operationtime,stoneoncecompleteclearancerate,postoperativehospitalstayandshort-termcomplicationsofESTgroupandEPBDgroupwerecompaied.ResultsTherewasnostatisticdifferenceintheage,sexratio,combinedduodenaldiverticulumbetweentwogroups.Thestonediameterwas(11.3+6.2)nuninESTgroupandthatwas(10.1+5.7)mminEPBDgroup・Therewasnostatisticdifferencebetweenthem(P=0.1056).TherewasnostatisticdifferenceinthestoneextractionmethodbetweenESTgroupandEPBDgroup・Theoperationtimewas(21.2+3・l)mininESTgroupandthatwas(20.7+2.5)mininEPBDgroup.Therewasnostatisticdifferencebetweenthem(P=0.1591).Thestoneoncecompleteclearanceratewas95.2%inESTgroupandthatwas94.5%inEPBDgroup.Therewasnostatisticdifferencebetweenthem(P=0.7828).Thepostoperativehospitalstaywas(4.1+1.9)dayinESTgroupandthatwas(4.1+2.0)dayinEPBDgroup・Therewasnostatisticdifferencebetweenlhem(P=1.0000).Theincidenceofshor...