双镜经胆囊管汇入部微切开并置入支架治疗胆道结石的临床效果及对凝胶形成MUC5 AC、CCKAR的影响  

Clinical application of microincision and stent placement through cystic duct on cholelithiasis treatment

作　　者：鲍鸿斌[1] 姚皓[1] 马大伟 徐浩奕 李宁[1] 刘昭明[1] BAO Hong-bin;YAO Hao;MA Da-wei;XU Hao-yi;LI Ning;LIU Zhao-ming(Department of Hepatobiliary Surgery Harrison International Peace Hospital,053000 Hengshui,Hebei,China)

机构地区：[1]哈励逊国际和平医院肝胆外科,河北衡水053000

出　　处：《临床消化病杂志》2024年第3期196-203,共8页Chinese Journal of Clinical Gastroenterology

基　　金：2020年度河北省医学科学研究课题计划(No:20200401)。

摘　　要：[目的]探讨双镜经胆囊管汇入部微切开并置入支架治疗胆道结石的治疗效果,并通过观察黏蛋白5 AC(MUC5 AC)、胆囊收缩素受体A(CCKAR)变化,对胆道结石形成的机制,尤其对治疗和预后监测的重要分子标记物,提供探索性指导和借鉴。[方法]选取胆管结石合并胆囊结石患者300例为研究对象,根据治疗方法分为对照Ⅰ组、对照Ⅱ组和实验组,每组100例。对照Ⅰ组采取腹腔镜胆总管切开胆道镜取石、T管引流术;对照Ⅱ组采取腹腔镜下胆囊切除术、胆总管切开胆道镜取石,内镜下于胆总管内留置鼻胆管;实验组采用双镜经胆囊管汇入部微切开并于胆总管内置入胰管支架。收集围手术期情况,对手术前后的血清丙氨酸氨基转移酶(ALT)等肝胆指标,MUC5 AC、CCKAR、总胆汁酸(TBA)、胆囊收缩素18(CCK-18),白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α)含量以及并发症情况进行对比,随访术后1年复发情况。[结果]实验组术中出血量、引流量、手术时间、住院时间显著低于对照Ⅰ组和对照Ⅱ组(P<0.05);取石时间较其他2组无明显差异,术后3组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、白细胞(WBC)、皮质醇(Cor)较术前显著降低,且实验组低于对照Ⅰ组和对照Ⅱ组(P<0.05);术后实验组炎症因子IL-6,TNF-α低于对照Ⅰ组和对照Ⅱ组(P<0.05);实验组并发症发病率显著低于对照Ⅰ组和对照Ⅱ组(P<0.05),3组结石残留率比较无显著差异(P>0.05);3组治疗有效率比较无显著差异,术后5年实验组复发率显著低于对照Ⅰ组和对照Ⅱ组(P<0.05)。3组血清MUC5 AC治疗后显著降低(P<0.05),血清CCKAR治疗后显著升高(P<0.05),实验组变化较明显;MUC5 AC、CCKAR治疗前差异无统计学意义(P<0.05)。UC5 AC、CCKAR在胆道结石患者胆囊组织中表达与正常胆囊组织比较差异有统计学意义(P<0.05)。MUC5 AC在胆道结石胆囊组织染色面积�[Objective]To explore the therapeutic effect of choledocholithiasis treated by microincision and stent placement through the entrance of cystic duct.by observing the changes of MUC5 AC and CCKAR,and provide exploratory guidance and reference for the mechanism of bile duct stone formation,especially searching the important molecular markers of treatment and prognosis monitoring.[Methods]The totals of 300 patients with cholangiolithiasis combined with cholecystolithiasis were selected as the study objects,and were divided into control groupⅠ,control groupⅡand experimental group according to treatment methods,with 100 cases in every group.The control groupⅠunderwent laparoscopic choledochotomy,choledochoscopy and T-tube drainage;the control groupⅡunderwent laparoscopic cholecystectomy,choledochotomy and choledochoscopy,and retained nasobiliary duct in the common bile duct;the experimental group underwent double endoscopy,microincision through the cystic duct and built-in pancreatic duct stent in the common bile duct.We collected the perioperative situation,compared the serum alanine aminotransferase(ALT)and other hepatobiliary indexes,MUC5 AC,CCKAR,TBA,CCK-18,IL-6,TNF-αcontent and complications before and after the operation,and followed up the recurrence situation one year after the operation.[Results]The bleeding volume,drainage volume,operation time,stone taking time and hospitalization time in the experimental group were significantly lower than those in the control groupⅠand the control groupⅡ(P<0.05).The alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),leukocyte(WBC),cortisol(COR)in the experimental group were significantly lower than those in the two control groups(P<0.05).The levels of IL-6 and TNF-αin experimental group were lower than those in control group(P<0.05);the incidence rate of complications in the experimental group was significantly lower than that in the two control group(P<0.05),and there was no significant difference in the residual stone rate

关 键 词：胆道结石 腹腔镜胆总管探查术 微创 支架 胆囊管汇入部 

分 类 号：R575.6[医药卫生—消化系统]