ERCP联合EST对胆总管结石患者肠道微生态及预后的影响  

Influence of endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy on intestinal microecology and prognosis in patients with choledocholithiasis

作　　者：贾昭 高艳红 张艳敏 李安平[2] 钱庆增 JIA Zhao;GAO Yanhong;ZHANG Yanmin(Department of Gastroenterology,Tangshan Central Hospital,Hebei,Tangshan 063000,China)

机构地区：[1]河北省唐山中心医院消化内科,063000 [2]河北省唐山市人民医院检验科 [3]华北理工大学公共卫生学院

出　　处：《河北医药》2023年第4期548-550,554,共4页Hebei Medical Journal

摘　　要：目的 探讨内镜逆行胰胆管造影(ERCP)联合内镜下十二指肠乳头括约肌切开取石术(EST)对胆总管结石患者肠道微生态及预后的影响。方法 选取2020年3月至2021年3月胆总管结石患者88例,采用随机数字表法分为对照组和观察组,每组44例。对照组实施开腹手术治疗,观察组实施ERCP联合EST治疗,于治疗前后行肠道微生态检测、生化指标评定,比较2组手术指征、临床疗效、并发症。结果 2组治疗后双歧杆菌、乳酸杆菌高于本组治疗前(P<0.05)。2组治疗后大肠杆菌、梭菌、拟杆菌、总胆红素、间接胆红素、直接胆红素、白细胞介素-6、C-反应蛋白低于本组治疗前(P<0.05)。观察组治疗后双歧杆菌、乳酸杆菌高于对照组(P<0.05)。观察组治疗后大肠杆菌、梭菌、拟杆菌、总胆红素、间接胆红素、直接胆红素、白细胞介素-6、C-反应蛋白低于对照组(P<0.05)。观察组手术时间、术后禁食时间、术后引流时间、术后住院时间短于对照组(P<0.05)。观察者术后1年内复发率、并发症总发生率低于对照组(P<0.05)。结论 ERCP联合EST可明显改善胆总管结石患者的肠道微生态状况,减轻体内炎性反应,缩短术后恢复时间,提高安全性。Objective To investigate the influence of endoscopic retrograde cholangiopancreatography(ERCP)combined with endoscopic sphincterotomy(EST)on intestinal microecology and prognosis in patients with choledocholithiasis.Methods Totally 88 patients with choledocholithiasis were enrolled in hospital from March 2020 to March 2021,they were randomized 1∶1 to receive laparotomy(the control group)or ERCP combined with EST(the observation group).Intestinal microecology and biochemical indexes were evaluated before and after treatment.Operation indication,clinical effect,complications were compared between the two groups.Results After treatment,Bifidobacteria,Lactobacilli in the two groups after treatment were significantly higher than those before treatment(P<0.05),which was more common in the observation group relative to the control group(P<0.05).After treatment,Escherichia coli,Clostridium,Bacteroides,total bilirubin,indirect bilirubin,direct bilirubin,interleukin-6,C-reactive protein in the two groups were significantly lower than those before treatment(P<0.05),which were significantly lower in the observation group than those in the control group(P<0.05).Operation time,postoperative fasting time,postoperative drainage time,postoperative hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05).Recurrence rate within postoperative 1 year,total incidence of complications in the observation group were lower than those in the control group(P<0.05).Conclusion ERCP combined with EST can significantly improve intestinal microecology in patients with choledocholithiasis,which can also reduce inflammatory reaction,shorten recovery time and improve safety.

关 键 词：内镜逆行胰胆管造影 内镜下十二指肠乳头括约肌切开取石术 胆总管结石 肠道微生态 预后 

分 类 号：R657.42[医药卫生—外科学]