探讨内镜下难治性胆总管结石行内镜逆行胰胆管造影(ERCP)取石的效果及安全性。

对2017年1月至2019年6月期间收治的92例胆总管结石患者进行前瞻性研究，采用随机数字表法将患者分为ERCP组和LCBDE(腹腔镜胆总管探查术)组，每组各46例。采用SPSS20.0软件进行数据处理，肝功能指标等计量资料采用独立t检验，两组取石成功率和并发症发生率等计数资料采用χ²检验；P<0.05为差异有统计学意义。

ERCP组一次取石成功率为82.6%(38/46)，二次取石成功率为71.4%(5/7)，总取石成功率为93.5%(43/46)，机械碎石使用率为82.6%(38/46)；LCBDE组一次性取石成功率为73.9%(34/46)，二次取石成功率为72.7%(8/11)，总取石成功率为91.3%(42/46)，机械碎石使用率为76.1%(35/46)。两组取石成功率及机械碎石使用率比较差异均无统计学意义(P>0.05)。两组患者术后7 d谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)水平均低于术前水平(P<0.05)；术后7 d ERCP组ALT、AST、TBIL水平明显低于LCBDE组(P<0.05)。两组术后并发症发生率比较差异均无统计学意义(P>0.05)。

ECRP取石术治疗难治性胆总管结石安全有效，在改善患者围术期情况更具优势，且促进术后恢复。

To investigate the effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) for refractory common bile duct stones.

A prospective study of 92 patients with choledocholithiasis admitted from January 2017 to June 2019 was conducted. The patients were divided into ERCP group and LCBDE group by random number table method. There were 46 cases in each group. SPSS20.0 software was used for data processing. Independent sample t test was used for the measurement data of liver function indicators in the two groups. Fisher’s exact probability test or χ² test were used for the data of lithotomy success rate and complication rate in the two groups. P<0.05 was considered statistically significant.

In the ERCP group, the success rate of one-time stone extraction was 82.6% (38/46), the success rate of second-time stone extraction was 71.4% (5/7), the total success rate of stone extraction was 93.5% (43/46), and the use rate of mechanical crushed stone was 82.6% (38/46); In the LBDEL group, the one-time stone extraction success rate was 73.9% (34/46), the second-time stone extraction success rate was 72.7% (8/11), the total stone extraction success rate was 91.3% (42/46), and the use rate of mechanical crushed stone was 76.1% (35/46). There was no statistically significant difference between the two groups in the success rate of stone removal and the utilization rate of mechanical gravel (P>0.05). The level of ALT, AST, and TBIL at 7 days after operation in the two groups was lower than the preoperative level, and the difference was statistically significant (P<0.05); The levels of ALT, AST and TBIL in ERCP group were significantly lower than those in LBDEL group 7 days after operation (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).

ECRP lithotripsy is safe and effective in refractory choledocholithiasis. It is similar to laparoscopic choledocholithotomy. ERCP has more advantages in improving patients’ perioperative conditions and promoting postoperative recovery.