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

摘要： 目的 比较经内镜逆行胰胆管造影术（ERCP）中不同取石方式去除10 mm以内胆总管结石的效果及安全性,为临床选用不同的取石方式提供依据。方法 回顾性分析2017年4月~2020年4月在我院行ERCP去除10 mm以内胆总管结石的449例患者临床资料,根据术中取石方式不同,分为网篮联合球囊组（161例）、单纯球囊组（94例）和单纯网篮组（194例）,比较三组在一次性结石清除率、近期并发症发生率以及远期结石复发率等方面的差别。结果 网篮联合球囊组、单纯球囊组和单纯网篮组一次性结石清除率分别为97.5%、94.7%和91.2%,网篮联合球囊组和单纯球囊组的一次性结石清除率均高于单纯网篮组,差异有统计学意义（P < 0.05）。网篮联合球囊组、单纯球囊组和单纯网篮组内镜取石术后高淀粉酶血症发生率分别为14.9%、19.1%和9.8%,术后胰腺炎发生率分别为4.3%、6.4%和3.1%,出血发生率分别为0.6%、2.1%和2.6%,差异均无统计学意义（P > 0.05）。网篮联合球囊组、单纯球囊组和单纯网篮组其胆总管结石复发率分别为1.9%、4.3% 和7.7%,网篮联合球囊组和单纯球囊组的胆总管结石复发率均低于单纯网篮组,差异有统计学意义（P < 0.05）。单独比较网篮联合球囊组和单纯球囊组其胆总管结石的一次清除率（97.5% vs. 94.7%）,术后高淀粉酶血症（14.9% vs. 19.1%）,胰腺炎发生率（4.3% vs. 6.4%）,出血发生率（0.6% vs. 2.1%）,胆总管结石复发率 （1.9% vs. 4.3%）,网篮联合球囊组的一次性结石清除率稍高于单纯球囊组,近期并发症发生率和远期结石复发率稍低于单纯球囊组,但差异均无统计学意义（（P > 0.05）。结论 对于内镜下去除10 mm以内胆总管结石时,选用网篮取石联合球囊廓清胆道对比单纯网篮或球囊治疗增加了一种取石器械,增加了手术步骤和时间,也增加了手术费用,但其具有较高的一次性结石清除率、较低的近期并发症发生率以及较低的远期结石复发率,从患者的疾病治愈和获益角度出发,在临床实际操作中建议选用网篮联合球囊取石的方式。

关键词: 胆总管结石, ERCP, 内镜取石术, 取石网篮, 取石球囊