| Objective:To investigate the clinical efficacy of small-middle endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in the treatment of complicated common bile duct stones in our hospital and to explore the preventive effect of traditional Chinese medicine such as Qingrelidan granules on the recurrence of stones.Methods:A total of 114 cases with complex choledocholithiasis(diameter?10 mm or number of stones?3)treated with ERCP from January 2012 to March 2017 in the First Affiliated Hospital of Dalian Medical University were retrospectively analyzed.Ninety-nine patients underwent SMEST+EPBD and 45 patients underwent conventional papillary sphincterotomy(EST).The rates of one-off removal of stones,the average hospitalization days after surgery,the average hospitalization expenses and the level of liver enzymology,were observed as well as recent postoperative complications such as hyper amylasemia,acute pancreatitis,acute cholangitis,hemorrhage and perforation.At the same time,two groups,traditional Chinese medicine group including 18 patients from SMEST+EPBD group treated with Qingrelidan Granule after operation and the other group including 51 patients given no Qingrelidan granules and other traditional Chinese medicines after operation as a control group were compared.The incidence of recurrence of stones withinone year was observed in both groups.Results: There were no significant difference(P>0.05)between two groups regarding the gender,age,history of cholecystolithiasis,cholecystectomy,common bile duct diameter,common bile duct stones,maximal calculus diameter,peri-papillary diverticula,diverticula nipple,preoperative TBIL,ALT,AST,r-GT and ALP.Compared with the EST group,SMEST+EPBD group had a higher one-off stone ratio and the difference was statistically significant(P<0.05).There were no statistical significance(P>0.05)between the two groups in the lithotripsy rate,stone basket utilization and stone balloon utilization rate.The hospitalization cost of SMEST+EPBD group was higher than that of EST group,but there was no statistical significance(P>0.05).By comparing the two groups of recent complications,the incidence of hypermylase in EST group was found higher than that in SMEST+EPBD group(P<0.05),which presents statistical significance(P>0.05).The incidence of pancreatitis in SMEST+EPBD group was lower,but the difference was not statistically significant(P>0.05).Other recent complications such as acute cholangitis,bleeding,perforation suggest no significant difference between the two groups(P>0.05).In the level of liver enzymology,the levels of TBIL,ALT,AST,r-GT and ALP in SMEST+EPBD group and EST group were obviously lower than those before treatment but with significant statistical difference(P<0.01).However,there was no significant difference between the two groups after treatment(P>0.05).The differences between the traditional Chinese medicine group and its control group regarding sex,age,gallstone,cholecystectomy history,maximal common bile duct diameter and common bile duct diameter,(P>0.05)had no statistical significance.The follow-up in 1 year showed that the recurrence rate of stone in the control group(5.9%)was higher than that in traditional Chinese medicine group,but the difference was not statistically significant(P>0.05).Conclusion:(1)In the SMEST+EPBD group and the EST group had similar effect on the rates of gravel,hospitalization early acute cholangitis,bleeding,perforation and other complications,but SMEST+EPBD was superior to EST in the rates of one-off removal of stones,acute hypercalcemia and pancreatitis.(2)Traditional Chinese medicine such as Qingrelidan granules may prevent some stones from recurrence after SMEST+EPBD.(3)SMEST+EPBD is a safe and effective minimally invasive technique for complex choledocholithiasis which is worth popularizing in clinic. |
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