ERCP指引下sEST+球囊扩张治疗JPDD合并胆总管结石的研究  

Study of ERCP-guided sEST+balloon Dilatation for the Treatment of JPDD Complicated with Choledocholithiasis

作　　者：崔雷雷 路萌 康洁[1] 迟宝权[1] 姜立杰[1] 赵鹏[1] CUI Leilei;LU Meng;KANG Jie;CHI Baoquan;JIANG Lijie;ZHAO Peng(Halison International Peace Hospital,Hengshui 053000,Hebei,P.R.China)

机构地区：[1]哈励逊国际和平医院,河北衡水053000

出　　处：《影像科学与光化学》2022年第3期525-530,共6页Imaging Science and Photochemistry

基　　金：河北省医学科学研究重点课题计划(2016014101Z)。

摘　　要：本研究探讨内镜逆行胰胆管造影术(ERCP)指引下乳头括约肌小切开(sEST)+球囊扩张治疗十二指肠乳头旁憩室(JPDD)合并胆总管结石效果。选取94例JPDD合并胆总管结石患者,分为老年组(47例,60~85岁)、非老年组(47例,35~59岁),均采取ERCP指引下sEST+球囊扩张治疗,统计手术情况、胃肠功能、并发症、手术前后肝功能[直接胆红素(DBIL)、总胆红素(TBIL)、谷丙转氨酶(ALT)]、应激反应[促肾上腺皮质激素(ACTH)、皮质醇(COR)、肾上腺素(A)、去甲肾上腺素(NE)]以及炎性指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]水平。结果发现,两组手术完成、胃肠功能恢复情况、并发症发生率无明显差异;术后肝功能指标均显著降低(P<0.05),但组间差异无统计学意义(P>0.05),术后1 d、术后3 d两组血清应激反应、炎性指标水平较术前增高,且术后1 d老年组均显著高于非老年组(P<0.05)。研究结果表明ERCP指引下sEST+球囊扩张治疗JPDD合并胆总管结石安全、有效,但老年患者应激、炎症反应更强。This study investigated endoscopic retrograde cholangiopancreatography(ERCP)-guided small endoscopic sphincterotomy(sEST)plus balloon dilatation in the treatment of juxtapapillary duodenal diverticulum(JPDD)complicated with choledocholithiasis.A total of 94 patients with JPDD complicated with choledocholithiasis were selected and divided into elderly group of 47 cases(60-85 years old)and non-elderly group of 47 cases(35-59 years old).Both of the group patients were treated with sEST+balloon dilation under the guidance of ERCP,and counted the gastrointestinal function,complications,liver function before and after surgery[direct bilirubin(DBIL),total bilirubin(TBIL),alanine aminotransferase(ALT)],stress response[adrenocorticotropic hormone(ACTH),corticosteroids(COR),adrenaline(A),norepinephrine(NE)]and inflammatory indicators[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]levels.The results showed that there was no significant difference in the completion of the operation,the recovery of gastrointestinal function,and the incidence of complications between the two groups.The postoperative liver function indexes were significantly decreased(P<0.05),while there was no significant difference between the two groups(P>0.05).After one and three days of operation,the levels of serum stress response and inflammatory indexes in the two groups were higher than those before operation,and the elderly group was significantly higher than the non-elderly group after one-day operation(P<0.05).The results showed that sEST+balloon dilation under the guidance of ERCP was safe and effective in the treatment of JPDD complicated with choledocholithiasis,but the elderly patients could have stronger stress and inflammatory reactions.

关 键 词：内镜逆行胰胆管造影术 乳头括约肌小切开 球囊扩张 十二指肠乳头旁憩室 胆总管结石 

分 类 号：R657.42[医药卫生—外科学]