胰管结石治疗方案的选择分析与比较  

Selection of treatment regimens for pancreatic duct stones:A comparative analysis

作　　者：董金斌 方卫兵 石益海 DONG Jinbin;FANG Weibing;SHI Yihai(Department of Gastroenterology,Gongli Hospital Affiliated to Naval Medical University,Shanghai 200135,China;Department of Medical Ultrasonics,Chizhou Second Hospital,Chizhou,Anhui 247100,China)

机构地区：[1]海军军医大学附属公利医院消化内科,上海200135 [2]池州市二院超声医学科,安徽池州247100

出　　处：《临床肝胆病杂志》2022年第11期2558-2564,共7页Journal of Clinical Hepatology

基　　金：上海市浦东新区卫生和计划生育委员会重点亚专业项目(PWZy2020-05);上海市浦东卫生委员会医学学科建设项目(PWYgf2021-08)。

摘　　要：目的收集并对比分析内镜逆行胰胆管造影(ERCP)、腹腔镜术和开腹手术三种方案治疗胰管结石(PDS)患者的临床资料及治疗效果,总结PDS治疗方案选择的经验,进一步研究探讨可行的使患者获益最大化、最优化的治疗方案。方法回顾性分析2014年6月—2018年12月海军军医大学附属公利医院治疗的131例PDS患者的临床资料。根据手术情况分为3组:ERCP组69例,腔镜组32例,开腹组30例。监测3组患者手术前后相关指标的变化;进一步对比分析腔镜组和开腹组的手术疗效。正态分布的计量资料两组间比较采用独立样本t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验或SNK-q检验。偏态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。手术前后相关指标差异比较采用重复测量资料的方差分析和Friedman检验。计数资料组间比较采用χ^(2)检验。结果131例PDS患者中Ⅰ型40例、Ⅱ型76例、Ⅲ型15例。腔镜组与开腹组主要手术方式的病例数比较差异无统计学意义(χ^(2)=1.93,P>0.05)。腔镜组和开腹组血WBC、CRP、PCT、HOMA-IR在手术前后的动态变化存在明显差异(F=24.68、χ^(2)=227.66、F=45.37、F=106.71,P值均<0.05)。腔镜组手术时长、术中出血量、术后首次排气时间、术后止痛药物应用频次、腹腔引流管拔除时间、术后近期并发症、术后平均住院时长等观察指标均较开腹组明显减少/缩短(t=-4.80、t=-9.43、Z=-6.78、t=-11.59、Z=-6.77、χ^(2)=9.24、t=-3.60,P值均<0.05)。ERCP组、腔镜组、开腹组术后近期并发症发生率分别为24.64%、28.13%、66.67%,差异有统计学意义(χ^(2)=17.12,P<0.05);ERCP组及腔镜组术后近期并发症发生率均显著低于开腹组(χ^(2)值分别为15.78、9.24,P值分别为<0.05、0.02)。ERCP组、腔镜组、开腹组治疗有效率分别为91.30%、93.75%、73.33%,3组间有效率差异有统计�Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography(ERCP),laparoscopy,and laparotomy in the treatment of pancreatic duct stones(PDS)by collecting related clinical data,to summarize the experience in selecting treatment regimens for PDS,and to further explore feasible treatment regimens that could maximize and optimize the benefits of PDS patients.Methods A retrospective analysis was performed for the clinical data of 131 PDS patients who were treated in Gongli Hospital Affiliated to Naval Medical University from June 2014 to December 2018,and according to the surgical procedure,they were divided into ERCP group with 69 patients,laparoscopy group with 32 patients,and laparotomy group with 30 patients.Related indices were monitored before and after treatment,and surgical outcome was compared between the laparoscopy group and the laparotomy group.The independent samples t-test was used for comparison of normally distributed continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test or the SNK-q test was used for further comparison between two groups.The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups.An repeated measures analysis of variance and the Friedman test were used for comparison of related indices before and after surgery,and the chi-square test was used for comparison of categorical data between groups.Results Among the 131 PDS patients,there were 40 patients with typeⅠPDS,76 with typeⅡPDS,and 15 with typeⅢPDS.There was no significant difference in the distribution of main surgical methods between the laparoscopy group and the laparotomy group(χ^(2)=1.93,P>0.05).There were significant differences between the laparoscopy group and the laparotomy group in the dynamic changes of white blood cell count,C-reactive protein,procal

关 键 词：胰管结石 胰胆管造影术 内窥镜逆行 腹腔镜检查 消化系统外科手术 

分 类 号：R576[医药卫生—消化系统]