Clinical Research About Small Endoscopic Sphincterotomy Combined With Balloon Expansion For The Treatment Of Common Bile Duct Calculi

Objective:To evaluate the efficacy and safety about small Endoscopic sphincterotomy combined with balloon expansion for the treatment of common bile duct calculi.Methods:In accordance with the requirements for prospective randomized controlled clinical trials, Selected from January 2013 to October 2014,,shanxi medical university first hospital in the hospital intends to do ERCP for the treatment of common bile duct calculi of 100 patients.Inclusion criteria: ≧ 18 age one full year of life, And after biliary imaging, CT, ultrasound and other relevant examination tips for common bile duct calculi.Exclusion criteria: always did EST or EPBD;Biliary strictures;Billrith-II or Roux-en-Y anatomy;Preoperative acute pancreatitis;Blood coagulation dysfunction(APTT prolong 2 times or PLT < 70 x109/ L);Biliary or pancreatic tumor affecting intubation.Severe lung disease should not line, Preoperative give ban eating six hours;Preoperative give muscle injection of diazepam 10 mg, 25 mg pethidine hydrochloride, calm, giving despun scopolamine injection 10 mg relaxation duodenal smooth muscle;Oraling Luo Ningjiao pulp local anesthesia, using the prone position, to tie the belt, and continue to give low flow, when administering oxygen inhalation through nasal catheter line of blood pressure, blood oxygen saturation, heart rate and ECG monitoring.Using selective intubation, knife with thread injection after successful intubation optimal show imaging showed after common bile duct calculi were randomlydivided into endoscopic duodenal papilla sphincterotomy(EST) and endoscopic duodenal papilla sphincter small incision combined with balloon dilatation(ESBD)group, 50 cases in each group.ESBD group first give tit small incision balloon expansion after stone extraction for any;EST group only line of small incision after nephrolithotomy.Results:In the EST and ESBD group there were 46 cases(92%), and 48 cases(96%) of disposable net calculi, P > 0.05;Using mechanical lithotripsy there were 8 cases(12%)and 2 cases(4%), P >0.05;EST group high amylase levels, 4 cases, 2 cases of acute pancreatitis, hemorrhage in 1 case;ESBD group high blood amylase occurred in 2 cases,1 case of acute pancreatitis, early complications of total incidence of 12% and 6%respectively, P > 0.05;The average operation time, respectively(39.84±10.08)min and(34.60±7.33)min, P < 0.05.Conclusions:Common bile duct calculi of ESBD treatment group take stone at one time success rate and the incidence of early postoperative complications is similar with EST group,but the average operation time and the use of low mechanical lithotripsy probability is low compared with EST,and ESBD has retained sphincter physiological barrier function.So treatment of common bile duct calculi with high efficacy and safety.