PTCSL术与ERCP+EST/ESBD术治疗胆总管结石的疗效及对肝功能、并发症风险的影响  

Effects of PTCSL and ERCP+EST/ESBD on choledocholithiasis and on liver function and complication risk

作　　者：罗维 楚章华 LUO Wei;CHU Zhanghua(Hepatobiliary Department,First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院肝胆外科,河南洛阳471000

出　　处：《中国医学工程》2024年第3期78-82,共5页China Medical Engineering

摘　　要：目的比较经皮经肝胆道镜取石术(PTCSL)与经内镜逆行胰胆管造影术(ERCP)+经内镜十二指肠乳头括约肌切开取石术(EST)/经内镜十二指肠乳头小切开后球囊扩张取石(ESBD)治疗胆总管结石(CBDS)患者的效果。方法选取2020年1月至2022年12月河南科技大学第一附属医院82例CBDS患者,按随机数字表法分成A组(n=41)、B组(n=41)。A组接受PTCSL术治疗,B组接受ERCP+EST/ESBD术治疗。比较两组手术指标、结石清除率、并发症发生率、手术前后肝功能指标[总胆红素(TBIL)、谷丙转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)]、应激指标[肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、白介素-6(IL-6)]水平。结果两组胆道引流管拔除时间比较,差异无统计学意义(P>0.05),与B组比较,A组住院耗时及胃肠功能恢复时间更短,手术耗时更长,术中失血量更多(P<0.05);A组结石清除率(100.00%,41/41)较B组(80.49%,33/41)高,并发症发生率(4.88%,2/41)较B组(21.95%,9/41)低(P<0.05);术后3 d、5 d两组血清TBIL、ALT、AST、ALP水平均较术前降低(P<0.05),但A组与B组比较,差异无统计学意义(P>0.05);术后3 d、5 d A组血清TNF-α、NO、IL-6水平较B组低(P<0.05)。结论ERCP+EST/ESBD术与PTCSL术与治疗CBDS患者均能有效改善肝功能,且各有优势,前者有助于缩短手术耗时,减少术中出血,后者有助于提升结石清除率,降低并发症发生风险,且对机体产生创伤应激反应小,可缩短患者康复进程。【Objective】To compare the efficacy of percutaneous transhepatic choledochoscopic lithotomy(PTCSL)with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic duodenal papillary sphincterotomy(EST)/endoscopic duodenal papillary sphincterotomy plus balloon dilation(ESBD)in the treatment of common bile duct stones(CBDS).【Methods】Eighty-two patients with CBDS treated in First Affiliated Hospital of Henan University of Science and Technology from January 2020 to December 2022 were selected and divided into group A(n=41)and group B(n=41)according to random number table method.Group A received PTCSL and group B received ERCP+EST/ESBD.Surgical indexes,stone clearance rate,complication rate,liver function indexes before and after surgery[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)],stress indexes[tumor necrosis factor-α(TNF-α),nitric oxide(NO),interleukin-6(IL)]were compared between the two groups.【Results】There was no significant difference in the extraction time of biliary drainage tube between the two groups(P>0.05).Compared with group B,the hospitalization time and gastrointestinal function recovery time of group A were shorter,the operation time was longer,and the intraoperative blood loss was greater(P<0.05).The stone clearance rate of group A[100.00%(41/41)]was higher than that of group B[80.49%(33/41)],and the complication rate of group A[4.88%(2/41)]was lower than that of group B[21.95%(9/41)](P<0.05).The levels of serum TBIL,ALT,AST and ALP in the two groups were decreased on the 3rd and 5th day after surgery(P<0.05),but there was no significant difference between group A and group B(P>0.05).The serum levels of TNF-α,NO and IL-6 in group A were lower than those in group B on the 3rd and 5th day after surgery(P<0.05).【Conclusion】Both ERCP+EST/ESBD and PTCSL can effectively improve liver function in the treatment of patients with CBDS,and each has its own advantages.The former is helpful to shorten the operation time and r

关 键 词：胆总管结石 并发症 肝功能 

分 类 号：R657.42[医药卫生—外科学] R616.5[医药卫生—临床医学]