A Comparision Study Bteween The Small Endoscopic Sphincterotomy Associated With Balloon Diatation And The Endoscopic Sphincter Sphincterotomy In Treatment Of Choledocholithsis

Objective:To investigate the effect of small endoscopic sphincterotomy plus balloon dilation vers large endoscopic sphincterotomy for common bile duct stones on the clearance rates of stones,the rate of post-ERCP pancreatitis、hemorrhageand、 perfortion,and the changes between preoperative liver functions and postoperative liver functions.Methods:We selected totally 396 patients from March 2015 to January 2017 in Nankai Hospital,and all the patients with common bile duct stones treated by the ERCP.According to the requirements of the randomized number table method,were randomized in equal numbers to EST group(200 patients)or s EST+EPBD group(196 patients).Inclusion criteria:age≥18 years,feasible to perform ERCP for the patients with common bile duct stones diagnosed by MRCP,abdominal CT,abdominal ultrasonography or EUS;patients after cholecystectomy or will be performed cholecystectomy.Exclusion criteria: Blood coagulation dysfunction Roux-en-Y anaomy(APTT prolong 2times or PLT<50×109/L)or other severe liver disease;combined with acute pancreatitis;sbutotal gastrectomy;bile duct segment stenosis;hepatobiliary and pancreatic malignant tumors;past EST or EPBD;severe lung disease shoulld not line.We can recorded the diameter of common bile duct、the size of stone、number of stones、the X-ray exposure time and operation time and so on.Measure 24 h of blood routine,12h、24h pancreatic function and 48 h of liver function,observing and recording 12 h,24h,48 h of temperature after operation,abdominal signs and the fluid of nasal biliary grainage(quantity and traits).Results:The disposable clearance rates of stones and the average X-ray exposure time were no significant statistical differences(P>0.05).There were significant statistical differences between the EST group(17.5%)and s EST+EPBD group(5.7%)in the rate of mechanical lithotripsy(P=0.00<0.05).There were significant statistical differences between preoperative liver functions and postoperative liver functions(P<0.05),but the differences of perioperative liver functions were no significant statistical differences(P>0.05).For the post-ERCP pancreatitis,the rates of the EST group(4.5%)and the s EST+EPBD group(3.6%)had no significant statistical difference(P=0.64>0.05). For the hemorrhage,the rates of the EST group(1.5%)and the s EST+EPBD group(1.0%)had no significant statistical difference(P=0.67>0.05).There have no case of digestive tract perforation in two groups.The complications of total incidient of EST group were higher than the s EST+EPBD group(6.5% VS 5.6%).Conclusions:The method of small endoscopic sphincterotomy plus balloon dilation to treat extrahepatic bile duct stone is safe and effective.It does not increase the incidient of postoperative pancreatitis in the short time,at the same time reduce the incidient of postoperative bleeding,perforation and the rate of use the intraoperative mechanical gravel.