关键词: 胆总管结石, ERCP, 内镜取石术, 取石网篮, 取石球囊

Abstract: Objective To compare the efficacy and safety of different devices to remove common bile duct stones within 10 mm in ERCP, to provide basis for clinical selection of different stone extractionmethods. Methods To retrospectively analyze the clinical data of 449 patients who underwent endoscopic removal of common bile duct stones within 10 mm in our hospital from April 2017 to April 2020. According to the different methods of stone removal, they were divided into the basket catheter combined with balloon catheter group （161 cases, A group） the simple balloon catheter group （94 cases, B group）and the simple basket catheter group （194 cases, C group）. The differences in the one-time clearance rate of common bile duct stones, the rate of short-term complications, and the stone recurrence rate were contrasted to the three groups. Results The one-time stone clearance rates of the A group, B group and C group were 97.5%, 94.7% and 91.2%, respectively. The one-time clearance rate of thea group and the B group was higher than that of the C group, and there was a statistically significant difference （χ²=6.406, P=0.041）. The rate of hyperamylaseemia in the A, B and C group was 14.9%, 19.1% and 9.8%, and the rate of PEP was 4.3%, 6.4% and 3.1%, respectively. The rate of bleeding were 0.6%, 2.1% and 2.6% respectively. And there were all no statistically significant difference（P>0.05）. The recurrence rates of common bile duct stones in A group, B group and C group were 1.9%、4.3% and 7.7% respectively. The recurrence rate of the A group and the B group was lower than that of the C group, and there was a statistically significant difference （χ²=6.609, P=0.037）. Separately compare the A group with the B group, the one-time clearance rates of common bile duct stones were 97.5% and 94.7%, the rate of hyperamylaseemia were 14.9% and 19.1%, the rate of PEP were 4.3% and 6.4%, the rate of bleeding were 0.6% and 2.1%, the recurrence rates of common bile duct stones were 1.9% and 4.3%, respectively. The one-time stone clearance rate of the A group was slightly higher than that of the B group. The short-term complication rate and the long-term stone recurrence rate of the A group were slightly lower than those of the B group, but the difference was not statistically significant （P>0.05）. Conclusion For endoscopic extraction of common bile duct stones within 10 mm, the combination of basket and balloon catheterhas increased one kind of extraction instrument, surgical procedure, management time and part of the operation costs, but it has higher one-time stone clearance rate, lower short-term complication rate and lower long-term stone recurrence rate. In clinical practice, we suggest to select the method of the basket combined with balloon catheter lithotomy.

Key words: common bile duct stones, ERCP, endoscopic extraction, basket catheter, balloon catheter