ERCP联合SpyGlass DS治疗困难胆管结石的临床疗效评价及预后评价  

Clinical efficacy evaluation and prognosis evaluation of ERCP combined with SpyGlass DS in the treatment of difficult bile duct stones

作　　者：马丽娜·阿新拜 张立平[1,3] 王林恒[1] 王允亮[1] 张欢 刘石磊 胡雨薇 姚玉璞[1] MALINA Axinbai;ZHANG Li-ping;WANG Lin-heng;WANG Yun-liang;ZHANG Huan;LIU Shi-lei;HU Yu-wei;YAO Yu-pu(Department of Gastroenterology,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China;Department of Integrative Medicine,School of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830017,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学东方医院脾胃肝胆科,100078 [2]新疆医科大学中医学院中西医结合系,830017 [3]北京中医药大学,100029

出　　处：《现代消化及介入诊疗》2023年第8期936-941,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：北京市自然科学基金项目(7212181);北京中医药大学重点攻关项目(2020-JYB-ZDGG-132)。

摘　　要：目的评价内镜逆行胰胆管造影术(ERCP)和ERCP+SpyGlass DS治疗困难胆管结石的临床疗效及预后。方法回顾性分析北京中医药大学东方医院内镜中心2020年1月至2023年6月收治的共80例行ERCP、ERCP+SpyGlass DS治疗的困难胆总管结石患者的临床资料,利用倾向性评分匹配法找到与ERCP+SpyGlass DS组病例匹配度最高的ERCP组病例,每组纳入40例患者,比较两组手术治疗情况、术后体温和症状及手术相关指标。结果两组患者手术操作时间差异有统计学意义(P<0.05),两组患者住院天数、一次取石成功率、需要进行二次取石率,差异均无统计学意义(P>0.05);ERCP组术后发热患者占5.0%(2/40)、持续性腹痛患者占7.5%(3/40)、右上腹出现新腹痛患者占10.0%(4/40)、呕血患者占0%(0/40)、黑便患者占7.5%(3/40);ERCP+SpyGlass DS组术后发热患者占2.5%(1/40)、持续性腹痛患者占0%(0/40)、右上腹出现新腹痛患者占0%(0/40)、呕血患者占0%(0/40)、黑便患者占5.0%(2/40);两组患者AMY下降率、CRP下降率、术前白细胞计数、白细胞计数下降率、术前TBIL水平、TBIL下降率、术前DBIL水平,差异有统计学意义(P<0.05)。两组患者术前AMY水平、术后24 h AMY水平、术前CRP、术后24 h CRP水平、术后24 h白细胞计数、术后TBIL水平、术后DBIL水平、DBIL下降率,差异均无统计学意义(P>0.05)。结论ERCP与ERCP+SpyGlass DS治疗困难胆管结石均安全可靠。ERCP联合SpyGlass DS临床疗效良好,预后积极,值得进一步推广。Objective To evaluate the clinical efficacy and prognosis of endoscopic retrograde cholangiopancreatography(ERCP)and ERCP+SpyGlass DS for treating difficult bile duct stones.Methods Clinical data of a total of 80 cases of patients with difficult choledochal stones treated by ERCP and ERCP+SpyGlass DS admitted to the Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine,Beijing,China,from January 2020 to June 2023 were retrospectively analyzed,and the propensity score matching method was utilized to find cases in the ERCP group that had the highest degree of match with cases in the ERCP+SpyGlass DS group,and 40 patients were included in each group,and surgical treatments,postoperative body temperatures and symptoms,and surgical-related indexes were compared between the two groups.Results The difference in surgical operation time between the two groups was statistically significant(P<0.05),and the differences in the number of days of hospitalization,the success rate of primary lithotripsy,and the rate of need for secondary lithotripsy between the two groups were not statistically significant(P>0.05);in the ERCP group,the percentage of patients with postoperative fever was 5.0%(2/40),the percentage of patients with persistent abdominal pain was 7.5%(3/40),and the percentage of patients who developed new abdominal pain in the right epigastrium was 10.0%(4/40),0%(0/40)of patients with vomiting blood,and 7.5%(3/40)of patients with black stools;in the ERCP+SpyGlass DS group,postoperative fever accounted for 2.5%(1/40)of patients,persistent abdominal pain accounted for 0%(0/40)of patients,new abdominal pain in the right epigastric region accounted for 0%(0/40)of patients,vomiting blood accounted for 0%(0/40)of patients,and black stools accounted for 5.0%(2/40)of patients.patients accounted for 5.0%(2/40);AMY decline rate,CRP decline rate,preoperative white blood cell count,white blood cell count decline rate,preoperative TBIL level,TBIL decline rate,and preoperative DBIL level of patients in the tw

关 键 词：困难胆管结石 内镜逆行胰胆管造影术 SpyGlass DS 临床疗效 预后 

分 类 号：R575[医药卫生—消化系统]