双镜微创术联合术后吲哚美辛栓治疗胆囊结石合并胆总管结石患者效果研究  

Role of post-operational indomethacin and gastroduodenoscopy and endoscopic retrograde biliary drainage combination in dealing with patients with cholecystolithiasis and choledocholithiasis

作　　者：沈玉根[1] 徐东林 Shen Yugen;Xu Donglin(Department of General Surgery,Central Hospital,Xuhui District,200031,Shanghai,China)

机构地区：[1]上海市徐汇区中心医院普外科,200031 [2]上海中医药大学附属曙光医院普外科

出　　处：《实用肝脏病杂志》2020年第4期605-608,共4页Journal of Practical Hepatology

基　　金：上海市科委科研基金资助项目(编号:16411951600)。

摘　　要：目的研究双镜微创术联合术后吲哚美辛栓治疗胆囊结石合并胆总管结石患者的效果及其对血清视黄醇结合蛋白(RBP)水平的影响。方法2017年2月~2018年4月我院治疗的胆囊结石合并胆总管结石患者120例,被随机分为对照组和观察组,每组60例,分别行双镜微创术和双镜微创术后给予吲哚美辛栓治疗。采用ELISA法检测血清RBP、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和IL-8水平,应用WHO推荐的生命质量(QOL)量表评估生命质量。结果两组均全部取净胆囊和胆总管结石;在治疗后7 d,观察组血清RBP水平为(45.8±3.2)mg/L,显著高于对照组【(32.5±3.2)mg/L,P<0.05】;血清TNF-α、IL-6和IL-8水平分别为(2.1±0.4)μg/L、(15.8±7.8)μg/L和(11.6±9.5)μg/L,显著低于对照组【分别为(4.1±0.4)μg/L、(30.8±7.7)μg/L和(37.6±9.5)μg/L,P<0.05】;术后3个月,两组患者胆管狭窄、切口感染、残留结石和胆漏发生率之间的差异不存在统计学意义(P>0.05);在术后1 m和3 m,观察组患者QOL评分分别为(45.8±3.2)和(47.2±3.0),显著高于对照组【分别为(32.5±3.3)和(36.1±3.1),P<0.05】。结论采用双镜微创术联合术后给予吲哚美辛栓治疗胆囊结石合并胆总管结石患者可显著抑制机体应激反应,降低血清细胞因子水平,提升血清RBP水平,治疗效果显著。Objective The purpose of this study was to observe the role of indomethacin in dealing with patients with cholecystolithiasis and choledocholithiasis after gastroduodenoscopy and endoscopic retrograde biliary drainage(ERBD)operation.Methods 120 patients with cholecystolithiasis and common bile duct stones were recruited in our hospital between February 2017 and April 2018,and they were randomly divided into control and observation group received gastroduodenoscopy and ERBD,and post-operational indomethacin anastomosis for 7 days.Serum retinol-binding protein(RBP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-8 levels were detected,and quality of life(QOL)score was evaluated.Result The surgical operation in the two groups was successful;at the end of 7 days after operation,serum RBP level in the observation group was(45.8±3.2)mg/L,significantly higher than【(32.5±3.2)mg/L,P<0.05】in the control,while serum TNF-α,IL-6 and IL-8 level were(2.1±0.4)μg/L,(15.8±7.8)μg/L and(11.6±9.5)μg/L,significantly lower than【(4.1±0.4)μg/L,(30.8±7.7)μg/L and(37.6±9.5)μg/L,respectively,P<0.05】in the control;three months post-operation,the incidences of biliary stricture,incision infection,residual stones and bile leakage in the two groups was not significantly different(P>0.05);at the end of one month and three months after operation,the QOL scores in the observation group were(45.8±3.2)and(47.2±3.0),much higher than【(32.5±3.3)and(36.1±3.1),respectively,P<0.05】in the control.Conclusion The role of indomethacin is obvious in patients with Choledocholithiasis after surgical operation,which might help elevate serum RBP level,decrease serum cytokine levels and improve QOL.

关 键 词：胆石症 腹腔镜 十二指肠镜 内镜下逆行胆汁引流 视黄醇结合蛋白 细胞因子 生命质量 

分 类 号：R657.42[医药卫生—外科学]