| Objective With the development of endoscopic technology,endoscopic retrograde cholangiopancreatography(ERCP)has gradually become an important way to treat choledocholithiasis.Its operation methods are mainly divided into endoscopic sphincterotomy(EST)and endoscopic papillary balloon dilatation(EPBD).However,EST and EPBD each have certain advantages.In this article,it is planned to study the preoperative,intraoperative,postoperative and long-term follow-up of EST and EPBD by retrospective comparative analysis.The aim is to clarify the respective advantages and practicability of EST and EPBD,to provide a good number of theoretical basis for clinicians to better develop and apply EST and EPBD technologies,to better help clinicians to select and apply EST and EPBD and to reduce corresponding postoperative complications and relieve patients’ pain and burden.Methods From January 2013 to January 2018,Patients who received ERCP lithotomy due to "choledocholithiasis" in Minda Hospital Affiliated to Hubei University for Nationalities were retrospectively collected.According to different surgical methods,they were divided into group EST and group EPBD.The gender,age,operation time,calculus diameter,number of calculus,calculus clearance rate,calculus residual rate,mechanical stone removal rate,time of first exhaust and defecation after operation,incidence of postoperative complications(hemorrhage,perforation,biliary tract infection,post-ERCP pancreatitis(PEP),etc.)of the two groups were compared and analyzed.At the same time,the patients were followed up for a longer time by telephone and succeeding medical records.And the calculus recurrence rates of the two groups were compared and analyzed.Results After(13 ~ 69)months of follow-up and screening of corresponding medical data,281 patients were included in this study.There were 138 cases in EST group,143 cases in EPBD group,129 cases in male and 152 cases in female.1.Comparison of basic preoperative conditions: The follow-up time of EST and EPBD groups was(40.94 ± 14.93)months VS(40.43 ± 15.54)months respectively.There was no significant difference in follow-up time between the two groups(P >0.05);The sex ratios of EST and EPBD were 84.00% VS 85.71% respectively.There was no significant difference in sex between the two groups(P > 0.05).The ages of EST and EPBD were(56.53 ± 14.46)years old VS(55.91 ± 14.42)years old respectively.There was no significant difference in age between the two groups(P >0.05).2.Comparison of basic conditions during operation: the calculus diameters of EST and EPBD groups were 0.8(0.5 ~ 2)cm VS 0.8(0.5 ~ 1.9)cm respectively.And there was no significant difference in calculus diameters between the two groups(P >0.05);The number of calculus in EST and EPBD groups was 1(1 ~ 3)VS 1(1~ 3)respectively,of which 71 cases(52.45%)VS 99 cases(69.23%)were single calculus in EST and EPBD groups respectively,67 cases(48.55%)VS 44 cases(30.77%)were multiple calculus respectively.The difference in the number of calculus between the two groups was statistically significant(P < 0.05).EST was mostly used for multiple calculus and EPBD was mostly used for single calculus;There were 131 cases(94.93%)VS 132 cases(92.31%)of EST and EPBD with complete calculus removal and 7 cases(5.07%)VS 11 cases(7.69%)with residual calculus.There was no significant difference in calculus removal rate and residual calculus rate between the two groups(P > 0.05).The use of mechanical lithotripsy in EST and EPBD groups was 6 cases(4.35%)VS 11 cases(7.69%)respectively.There was no significant difference in mechanical lithotripsy rate between the two groups(P > 0.05).The operation time of EST and EPBD were(22.71 ± 4.77)min VS(23.35 ± 4.32)min respectively.And there was no significant difference between the two groups in the operation time(P > 0.05).3.Comparison of basic conditions after operation: the time of first exhaust and defecation after operation in EST and EPBD groups was 23(17 ~ 37)h VS 19(13 ~ 35)h respectively.The difference between the two groups was statistically significant(P< 0.05).The time of first exhaust and defecation after operation in EST group wasrelatively later than that in EPBD group.The total postoperative complications in EST and EPBD groups were 29 cases(21.01%)VS 24 cases(16.78%)respectively.There was no significant difference in the total postoperative complications between the two groups(P > 0.05).EST and EPBD groups all had bleeding or perforation after operation.PEP occurred in 6 cases(4.35%)VS 16 cases(11.19%)after operation in EST and EPBD groups respectively.There was a statistically significant difference in PEP between the two groups(P < 0.05)after operation.PEP occurred after operation in EPBD group was relatively higher than that in EST group.Biliary tract infection occurred in 10 cases(7.25%)VS 3 cases(2.10%)after operation in EST and EPBD groups respectively.The difference in postoperative biliary tract infection between the two groups was statistically significant(P < 0.05).Biliary tract infection occurred after operation in EST group was relatively higher than that in EPBD group.There were 13 cases(9.42%)VS 5 cases(3.50%)of postoperative stone recurrence in EST and EPBD groups respectively.The difference of calculus recurrence between the two groups was statistically significant(P < 0.05).Among them,2 cases(28.57%)VS 2cases(18.18%)of residual calculus recurrence after secondary operation for calculus removal were respectively.The difference of postoperative residual calculus recurrence between the two groups was not statistically significant(P > 0.05).Recurrence of non-residual calculus was 11 cases(8.40%)VS 3 cases(2.27%)respectively.The difference between the two groups was statistically significant(P <0.05).Postoperative recurrence of calculus in EST group was relatively higher than that in EPBD group.Conclusion 1.EST and EPBD have the advantages of high calculus clearance rate,low incidence of complications and other advantages in ERCP lithotomy.The curative effect is safe and reliable,which is worthy of clinical promotion and application.2.In ERCP lithotomy,EST incision of Oddi sphincter has relatively great influence on gastrointestinal function.Recurrence of calculus and biliary tract infection are relatively high. |
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