The Clinical Diagnosis And Treatment Of Non-Dilated Extrahepatic Biliary Stones

Objective:To analyze and state the clinical features of non-dilated extrahepatic biliary stones,and compare the clinical effects and safety among endoscopic sphincterotomy(EST),endoscopic sphincterotomy with endoscopic papillary balloon dilation(EST+EPBD)and exploratory laparotomy on non-dilated extrahepatic biliary stones.Methods:A total of 188 patients with non-dilated extrahepatic biliary stones from2010-2016 in The Second People's Hospital of Wuhu City were retrospectively analyzed.According to the procedure they received,these patients were devided into endoscopic sphincterotomy group(EST group,n=33),endoscopic papilla balloon dilatation group(EST+EPBD group,n=35)and exploratory laparotomy group(n=120).Results:There were significant differences in the operative time and hospitalization stays among these three group(p<0.05).Compared with exploratory laparotomy group,there were longer operative time in EST group and EST+EPBD group,the longest time in EST group(p<0.05).Compared with EST+EPBD group,there were longer hospitalization stays in EST group and exploratory laparotomy group,the longest stays in exploratory laparotomy group(p<0.05).For the short-term complications,there were 6cases of hyperamylasemia in EST group(18.18%),4 cases in EST+EPBD group(11.43%)and 3 cases in exploratory laparotomy group(2.5%),c~2=10.744,p<0.05;there were 4 cases of pancreatitis in EST group(12.12%),1 case in EST+EPBD group(2.86%)and 2 cases in exploratory laparotomy group(1.67%),c~2=6.316,p<0.05.There were significant differences in the hyperamylase and pancreatitis.While in the perforation,bleeding and infection of biliary tract,there were no significant differences.For the long-term complications,there were 3 cases of stone recurrence in EST group(9.09%),1 case in EST+EPBD group(2.86%),25 cases in exploratory laparotomy group(20.83%),c~2=7.943,p<0.05;there were 6 cases of biliary retrograde infection in EST group(18.18%),3 cases in EST+EPBD group(8.57%),5 cases in exploratory laparotomy group(4.17%),c~2=6.777,p<0.05.Conclusion:The non-dilated extrahepatic biliary stones is the special type of extrahepaticbiliarystones.ComparedwithESTandexploratory laparotomy,EST+EPBD is the most feasible and safest in the patients.It has the advances of minimally invasive surgery such as small incision,definite effect,fast recovery,less complications except expenseness.If economy allowed,we should choose EST+EPBD for the non-dilated extrahepatic biliary stones.