比较直径10mm球囊与直径8mm球囊在胆总管结石乳头扩张方面的优势:一项配对队列研究

时间:2018-09-11 作者:翻译:胡越 审校:张 点击:1026次

比较直径10mm球囊与直径8mm球囊在胆总管结石乳头扩张方面的优势:一项配对队列研究。
 
 
摘要:在胆总管结石的治疗中,内镜乳头球囊扩张术(EPBD)可能是内镜下括约肌切开术(EST)的替代疗法。迄今为止,尚无直径10mm扩张球囊与直径8mm扩张球囊相比较的文献。
方法:从1994年5月至2014年1月,在日本两个三级护理中心对胆总管结石患者进行了EPBD治疗。产生了10 mm和8 mm EPBD的配对。比较两组患者的近期和远期疗效。
结果:共确定出869例(分别为10 mm的61例和8 mm 的808例),并产生61对平衡良好的配对。10 mm EPBD组单次完全取石率高于8mm EPBD组(69%vs44%,P<0.001),10 mm EPBD组机械碎石使用率较低(23%vs56%,P<0.001)。ERCP术后胰腺炎发生率10 mm组与8 mm EPBD组相似(分别为11%和8%)。两组EPBD术后1年胆道并发症发生率分别为88%(95%可信区间:79-97%)和94%(95%可信区间:88-100%),术后2年分别为69%(95%可信区间:56-85%)和80%(95%可信区间:69-93%)。10 mm EPBD组未见急性胆管炎,随访期间有5%的病例发现有胆道积气。
结论:使用直径10mm球囊进行乳头扩张治疗胆总管结石和直径8mm球囊相比是更为安全和有效的。使用直径10 mm球囊扩张乳头后,乳头括约肌功能保持良好.
 
Superiority of 10-mm-wide balloon over 8-mm-wide balloon in papillary dilation for bile duct stones: A matched cohort study.

Superiority of 10-mm-wide balloon over 8-mm-wide balloon in papillary dilation for bile duct stones: A matched cohort study.

Akiyama D, Hamada T, Isayama H, et al. Saudi Journal of Gastroenterology Official Journal of the Saudi Gastroenterology Association, 2015, 21(4):213.
 
Abstract
Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy (EST) for common bile duct (CBD) stones. To date, 10- and 8-mm EPBD have not been fully compared. Patients who underwent EPBD for CBD stones at two Japanese tertiary care centers between May 1994 and January 2014 were identified. Matched pairs with 10- and 8-mm EPBD were generated. Short- and long-term outcomes were compared between the two groups. A total of 869 patients were identified (61 and 808 patients for 10- and 8-mm EPBD, respectively), and 61 well-balanced pairs were generated. The rate of complete stone removal within a single session was higher in the 10-mm EPBD group than in the 8-mm EPBD group (69% vs. 44%, P < 0.001), and use of lithotripsy was less frequent in the 10-mm EPBD group (23% vs. 56%, P < 0.001). The rates of post-ERCP pancreatitis were similar between the 10- and 8-mm EPBD groups (11% vs. 8%). Cumulative biliary complication-free rates were not statistically different between the two groups: 88% [95% confidence interval (CI): 79-97%] and 94% (95% CI: 88-100%) at 1 year and 69% (95% CI: 56-85%) and 80% (95% CI: 69-93%) at 2 years in the 10- and 8-mm EPBD groups, respectively. In the 10-mm EPBD group, ascending cholangitis was not observed, and pneumobilia was found in 5% of cases during the follow-up period. EPBD using a 10-mm balloon for CBD stones is safe and more effective than 8-mm EPBD. The sphincter function is highly preserved after 10-mm EPBD.

翻译:胡越  审校:张立超、侯森林