The Efficacy Observation Of Small Endoscopic Sphincterotomy Combined With Different Dilation Duration Of Endoscopic Papillary Balloon Dilation In The Treatment Of Choledocholithiasis

Objective: To investigate the efficacy and safety of sEST combined with EPBD in the treatment of choledocholithiasis by comparing the duration of balloon dilatation ≤1min and the duration of balloon dilatation 1-3min after sEST in patients with choledocholithiasis <10mm in diameter,and to provide clinical treatment guidance for the duration of EPBD after sEST.Methods: The clinical data of 141 patients with choledocholithiasis <10 mm in diameter who underwent sEST combined with EPBD in the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University from October 2021 to October 2022 were retrospectively analyzed,according to the balloon dilation duration,they were divided into short-term dilation group(≤1min)group(n=73)and delayed dilation group(1-3min)group(n=68).Collect and sort out the general condition data,imaging data,operation records,nursing records,laboratory examination indicators,follow-up data and other relevant data of patients,and compare and analyze the efficacy and safety of surgery with two different dilatation durations by statistical methods.Results:1.Stones were removed in 134 of 141 patients,and the stone removal rate was 95.0%.Among them,68 cases(93.2%)were in the short-term dilatation group and 66 cases(97.1%)were in the delayed dilatation group,and there was no significant difference in the stone removal rate between the two groups(p>0.05).2.PEP developed in 11 of 141 patients,giving an incidence of approximately 7.8%.Among them,PEP occurred in 9 patients(12.3%)in the short-term dilatation group and 2patients(2.9%)in the delayed dilatation group,and there was a significant difference in multivariate analysis between the two groups(p<0.05),and the incidence was significantly lower in the delayed dilatation group than in the short-term dilatation group.3.HP was present in 16 of 141 patients,giving an incidence of approximately 11.3%.Among them,12 patients(16.4%)in the short-term expansion group and 4 patients(5.9%)in the delayed expansion group developed HP,and there was no significant difference after multivariate analysis between the two groups(p>0.05).Conclusion:1.sEST combined with EPBD is effective and high-quality in the treatment of choledocholithiasis <10mm in diameter,with short-term balloon dilatation(≤1min)and delayed dilatation(1-3min).2.According to the analysis of postoperative complications,for the treatment of choledocholithiasis < 10 mm in diameter,delayed balloon dilatation after sEST(1-3min)has a lower incidence of postoperative pancreatitis than short-term dilatation(≤1min)and has a higher surgical safety.