ERCP联合钬激光碎石治疗对难治性胆总管结石患者肠黏膜屏障功能及血清炎症水平的影响  

Joint Effect of ERCP and Holmium Laser Lithotripsy on Intestinal Mucosal Barrier Functions and Serum Inflammation Levels in Patients with Refractory Common Bile Duct Stones

作　　者：胡何英 栾吉坦 朱美静 HU Heying;LUAN Jitan;ZHU Meijing(Department of Gastroenterology,Chengyang District People's Hospital,Qingdao 266109,China)

机构地区：[1]青岛市城阳区人民医院消化内科,青岛市266109

出　　处：《中国激光医学杂志》2024年第4期208-213,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的分析内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)联合钬激光碎石术对难治性胆总管结石患者肠黏膜屏障功能和炎症水平的影响。方法选择2021年1月至2023年12月,胆总管结石患者120例,按照手术方式不同分为对照组和研究组,每组患者60例。其中,对照组采用传统手术治疗;研究组采用ERCP联合钬激光碎石术,碎石功率60 W,比较两组手术相关指标,术前和术后3 d肠黏膜屏障功能指标(包括血清内毒素、D-乳酸水平、大肠杆菌、乳酸杆菌和双歧杆菌)和炎症因子(包括IL-6、IL-1β和TNF-α)水平。结果与对照组比较,研究组患者手术时间和住院时间显著减少,术中出血量也显著降低(P<0.05);同时,与术前比较,两组患者术后肠黏膜屏障功能均受损,D-乳酸和内毒素水平显著升高(P<0.05),但研究组D-乳酸水平明显低于对照组(P<0.05),受损程度较轻,且清除结石后,研究组患者肠道内微生态环境改善程度优于对照组,乳酸杆菌和双歧杆菌高于对照组(P<0.05)。此外,术后两组患者炎症水平均升高,但研究组IL-6、IL-1β和TNF-α均显著低于对照组(P<0.05)。结论相比于传统开腹手术,ERCP联合钬激光碎石术有利于患者术后恢复,且对患者肠黏膜功能和应激反应影响较小,值得临床推广应用。Objective To analyze the joint effect of ERCP and holmium laser lithotripsy on the intestinal mucosal barrier functions and inflammation levels in patients with refractory choledochal stones.Methods Totally 120 patients diagnosed with common bile duct stones in our hospital between Jan.2021 and Dec.2023 were selected and divided by surgical methods into two groups:control group(traditional surgery group,n=60)and study group(ERCP+holmium laser lithotripsy group,n=60).The surgery-related indexes and the indexes of intestinal mucous membrane barrier functions and levels of inflammation before the surgery and 3 days after the surgery were compared between two groups.Results The operation and hospitalization durationand intraoperative bleeding of the patients in the study group were much less than those of the patients in the control group(P<0.05).For the patients in both groups,the barrier functions of intestinal mucosa were impaired and the levels of D-lactic acid and endotoxin significantly after the surgery(P<0.05).In addition,the level of D-lactic acid was much lower in the study group than in the control group(P<0.05),the degree of the impairment was less severe in the study group,the improvement to the microecological environment in the intestinal tract was better in the study group after the removal of the stones,and the levelsof Lactobacillus and Bifidobacterium were higher in the study group(P<0.05).Furthermore,the inflammation levels were elevated in both groups after the surgery,but the IL-6,IL-1βand TNF-αwere significantly lower in the study group than in the control group(P<0.05).Conclusions The combination of ERCP and holmium laser lithotripsy is worthy of recommendation as it is beneficial to patients'postoperative recovery and has less impact on patients'intestinal mucosal functions and stress responses while being compared with the traditional surgery.

关 键 词：ERCP 钬激光碎石 胆总管结石 肠黏膜屏障 炎症水平 

分 类 号：R616.4[医药卫生—外科学] R657.4[医药卫生—临床医学]