Abstract: Objective To compare the effects of two surgical methods (duodenal papillary reconstruction and small duodenal papillary incision+large balloon dilation) on Oddi’s sphincter function in patients with common bile duct stones.Methods From January 2021 to December 2022,64 patients with large common bile duct stones underwent endoscopic retrograde cholangiopancreatography (ERCP) stone removal surgery,which were randomly divided into two groups using a lottery method (32 cases each).Group A underwent ECPP,while Group B underwent limited EST plus EPLBD.Before the procedure,immediately after procedure,and one month after procedure,duodenal pressure measurements (Oddi sphincter basal pressure,maximum systolic pressure,and systolic frequency) were conducted to observe changes in various measurement indicators,and to compare the incidence of short-term and long-term complications between the two groups.Results The basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in both groups immediately after the operation and one month after the operation showed a trend of first decreasing and then increasing,and were all lower than those before the operation,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the basic pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter immediately after surgery between the two groups (P>0.05).One month after the operation,the basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in group A were (21.12±4.08) mmHg,(113.60±12.07) mmHg and (6.10±0.96) times/minute,respectively.The values in group B were (16.28± 1.64) mmHg,(104.19±19.25) mmHg,and (5.68±1.02) beats/minute,respectively.The values in group A were all higher than those in group B,and the differences were statistically significant(P<0.05).The incidences of gas reflux in group A at 1 week,6 months and 12 months after surgery were 6.25%,3.13% and 0 respectively,while those in group B were 21.88%,15.63% and 12.50% respectively.The incidences of barium reflux in group A were 3.13%,0 and 0 respectively,and those in group B were 12.50%,9.38% and 6.25% respectively.There were statistically significant differences between the two groups (P<0.05).The total incidence of short-term and long-term complications after surgery was close (34.38% and 31.25%),and there was no statistically significant difference between the two groups (P>0.05).Conclusion Compared with limited EST plus EPLBD,ECPP is more helpful for the recovery of Oddi’s sphincter function,and this surgical procedure is simple to operate without increasing the risk of postoperative complications.

Key words: Oddi sphincter, duodenal papillary reconstruction, small duodenal papillary incision, common bile duct stones