| Research background and Objective Choledocholithiasis is considered as a clinically common biliary system disease.Endoscopic Sphincterotomy(EST)in combination with Endoscopic Papillary Balloon Dilatation(EPBD)has been widely used in clinical.It has the advantages of improving the clearance of bile duct stones,avoiding excessive oppression of the pancreatic duct,reducing the risk of acute pancreatitis and severe pancreatitis,and reducing the risk of bleeding and perforation.It can also reduce the risk of the loss of nipple muscle function due to EST damage and the long-term complications associated with it.The optimal duration of EPBD has not been determined accurately.So this experiment by means of Endoscopic Sphincterotomy combined with Endoscopic Papillary Balloon Dilatation in the treatment of common bile duct calculi patients with clinical observation,the study of different duration EPBD(0 s,30 s,1 min,3 min,5 min)recent complications such as postoperative acute pancreatitis related indicators,discusses EST joint EPBD surgery the best duration balloon expansion.Method This study selected 126 patients with choledocholithiasis in the Second Hospital Affiliated to Guangzhou Medical University from April 2016 to March 2017.Among them,22 patients underwent EST combined with EPBD,and then were stopped dilatation(immediately after dilation).24 patients underwent EST combined with EPBD dilation for 30s(30s after expansion);25 patients underwent EST combined with EPBD dilation for 1minute(1 minute after expansion);31 patients underwent EST combined with EPBD dilation for 3 minute(3 minute after expansion);24 patients underwent EST combined with EPBD dilation for 5 minute(5 minute after expansion).Result(1)The risk of bleeding in group 0s was significantly different from those in the other four groups(P < 0.005),and 0s group(10,45.5%)was higher than the other 4 groups.There was no significant difference among group 30s(6,25%),group 1min(3,12%),group 3min(3,9.7%),and group 5min(2,8.3%)(P = 0.006 > 0.005).(2)There was no significant difference being found in the risk of postoperative bleeding among group 0s(9.1%),group 30s(4.2%),group 1min(0%),group 3min(0%)and 5min(4%)(P > 0.05).(3)There was no significant difference being found in the probability of postoperative acute cholangitis among all groups(P > 0.05).(4)There was no significant difference being found in the probability of postoperative hyperamylasemia among all groups(P > 0.05).(5)There were significant differences in the incidence of postoperative acute pancreatitis between the group 0s,group 30 s group 1min,group 3min and group 5min(P < 0.01).The incidence of mild acute pancreatitis was the highest in group 0s(45.5%),followed by the group 30 s and the group 5min(both 25.0%),then in the group 1min(16.0%),and the group 3min(3.2%)had the lowest incidence of postoperative pancreatitis.There was no significant difference in the incidence of moderate to severe acute pancreatitis among the 5 groups(P > 0.05).Conclusion(1)EST combined with EPBD can reduce the risk of intraoperative bleeding.Balloon dilatation time has a negative correlation with the incidence of intraoperative bleeding and mild bleeding.The longer the EPBD expansion time is,the lower the risk of intraoperative blood infiltration and mild bleeding.(2)EST combined with EPBD has a lower incidence of postoperative cholangitis,but the incidence of biliary tract infection has no significant relationship with the time of EPBD dilation,that is,the different dilatation time of EPBD has no effect on the occurrence of cholangitis after ERCP.(3)Different dilation time of EPBD had no effect on the occurrence of hyperamylasemia after ERCP.(4)Different dilation time of EPBD has an effect on the occurrence of acute pancreatitis after ERCP.The duration of dilation is too short(less than 30 seconds)or too long(5 minutes),which is easier to cause postoperative acute pancreatitis.The best EPBD dilation time can be maintained from 1 minutes to 3 minutes,which can reduce the risk of postoperative acute pancreatitis. |
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