Clinical Analysis Of Endoscopic Sphincterotomy (EST) And Endoscopic Papilla Spherical Balloon Dilatation (EPBD) In The Treatment Of Elderly Patients With Common Bile Duct Stones

Background:Choledocholithiasis is a common clinical disease with higher incidence.Itcan cause severe diseases such as acute pancreatitis, acute suppurativecholangitis.Patients over the age of60,even if no obvious symptoms andpositive signs found, also often have potential risk factors such as hardening ofthe arteries,poor heart, lung, and kidney function, diabetes andcancer.Complexity of the pathology and physiology of old people lead to poortolerance of surgery and anesthesia.Along with the development of medicine,therapeutic ERCP play an increasingly important role in the clinical works,with its curative effect is distinct, with less trauma, rapid recovery aftertreatment and can be repeatedly favored by more and more clinical workers.Inthe process of the development of therapeutic ERCP and EndoscopicSphincterotomy nipple (Endoscopic Sphincterotomy, EST) lithotomy hasgradually become the preferred treatment of common bile duct stones, with thecontinuous improvement of technology, many clinicians believe thatEndoscopic Papillary Balloon Dilatation ball (Endoscopic Papillary BalloonDilatation and EPBD) with its advantages of less complications and betterprotect the papilla sphincter which will replace EST. Purpose:To discuss the clinical value of Endoscopic papillary spherical balloondilatation (EPBD) in the treatment of common bile duct calculi.Method:One hundred and eighty patients with choledocholithiasis to do ERCPwere selected who stayed in Department of Hepatopancreatobiliary Surgery ofFirst Hospital of Jilin University,randomly divided into EST and EPBD group,90cases in each group,Patients were≧60years old.EPBD group after thespherical balloon expansion of duodenal papilla,and take out the stones byStone-extractor or Extraction-balloons.EST group according to normaloperation.Two groups are routine in ENBD after surgery for three days,andcheck out by radiography.Result:The rate of removed common bile duct stones successful respectively in88cases (98%) and89cases (99%) between EST and EPBD group.Totalincidence of early postoperative complications respectively for26cases (29%)and30cases (33%).Postoperative incidence of high blood amylase,respectively for20cases (22%) and24cases (26%). Postoperative incidence ofacute pancreatitis respectively for4cases(4%) and6cases (6%).There were2(2%) postoperative hemorrhage cases in EST group,There was nopostoperative gastrointestinal perforation and death case in two groups.Conclusion:EST and EPBD,the two operative methods with similar stone-free rate,theincidence rate of two groups of patients with pancreatitis were near in earlypostoperative monitoring visible,But the incidence rate of postoperative hemorrhage and intestinal perforation risk in EST group is higher relatively tothe EPBD group.It is thus clear that, EPBD can be as the preferred therapy fortreatment of elderly patients with common bile duct calculi.