不同球囊扩张时间对老年胆管结石EST术患者净石率、肝功能、应激程度及术后胰腺炎影响

Effects of different balloon dilation time on stone clearance rate,liver function,stress level and postoperative pancreatitis in elderly patients with bile duct stones undergoing EST

目的探讨不同球囊扩张时间对老年胆管结石内镜下十二指肠乳头括约肌切开术(bile duct stones undergoing endoscopic sphincterotomy,EST)患者净石率、肝功能、应激程度及术后胰腺炎影响,指导临床选择最佳球囊扩张时间。方法选取老年胆管结石患者116例,按照随机数字表法均分为1 min组、3 min组,各58例。2组均给予EST治疗,1 min组、3 min组球囊扩张时间分别为1 min、3 min,比较2组手术一般情况、取石情况、肝功能[γ-谷氨酰转移酶(γ-glutamyltransferase,γ-GT)、丙氨酸转氨酶(alanine aminotransferase,ALT)、碱性磷酸酶(alkalinephosphatase,ALP)、直接胆红素(direct bilirubin,DBIL)、总胆红素(total bilirubin,TBIL)]、应激程度[环氧合酶2(cyclooxygenase-2,COX-2)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)、皮质醇(cortisol,Cor)]及并发症。结果3 min组手术时间短于1 min组,术中出血量低于1 min组,差异有统计学意义(P<0.05);3 min组术后住院时间、X线暴露时间与1 min组比较,差异无统计学意义(P>0.05);3 min组机械碎石率、一次净石率、取石时间与1 min组比较,差异无统计学意义(P>0.05);2组术后1 d、术后3 dγ-GT、ALP、ALT、DBIL、TBIL均呈现降低趋势,2组在时点间、组间·时点间交互作用差异有统计意义(P<0.05),在组间差异无统计学意义(P>0.05);2组术后1 d、术后3 d COX-2、TNF-α、CRP、Cor均呈升高趋势,2组在时点间、组间·时点间交互作用差异有统计意义(P<0.05),在组间差异无统计学意义(P>0.05);2组术后1 d、术后3 d血淀粉酶、脂肪酶均呈升高趋势,2组在组间、时点间、组间·时点间交互作用差异有统计意义(P<0.05),3 min组术后1 d、术后3 d血淀粉酶、脂肪酶低于1 min组(P<0.05);3 min组胰腺炎、出血发生率低于1 min组,差异有统计学意义(P<0.05);3 min组与1 min组胆道感染发生率比较,差异无统计学意义(P>0.05)。结论EST术中球囊扩张3 min应用于老年胆管结石患者,可有效减少术中出血,缩短手术时间,在保证取石效果,不影响肝功能、创伤应激程度的同时,有效避免胰腺炎、出血发生。

Objective To investigate the effect of different balloon dilation time on the stone clearance rate,liver function,stress level and postoperative pancreatitis in elderly patients with bile duct stones undergoing endoscopic sphincterotomy(EST)of the duodenal papilla,so as to guide the optimal balloon dilation time in clinical practice.Methods A total of 116 elderly patients with bile duct stones were selected and divided into a 1-min group(n=58)and a 3-min group(n=58)according to the random number table method.Both groups received EST treatment,with balloon dilation times of 1 min and 3 min for the 1-min and 3-min groups,respectively.The general surgical conditions,stone removal,and liver function[γ-glutamyltransferase(γ-GT),alanine aminotransferase(ALT),alkaline phosphatase(ALP),direct bilirubin(DBIL),total bilirubin(TBIL)],stress level[cyclooxygenase-2(COX-2),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),cortisol(Cor)],and complications of the two groups were compared.Results The duration of operation in the 3-min group was shorter than that in the 1-min group,and the intraoperative blood loss was lower than that in the 1-min group,showing significant difference(P<0.05).There was no significant difference in length of postoperative hospital stay and X-ray exposure time between the 3-min group and the 1-min group(P>0.05),as well as in the mechanical lithotripsy rate,one-time stone clearance rate and stone removal time between the 3-min group and the 1-min group(P>0.05).At 1 d and 3 d after operation,γ-GT,ALP,ALT,DBIL and TBIL in the two groups showed a decreasing trend,and there were significant differences in interaction between groups,time points,and time points between groups(P<0.05),but there was no significant difference between two groups(P>0.05).COX-2 and TNF-α,CRP and Cor of the two groups at 1 d and 3 d after operation showed an increasing trend,and there were significant differences in interaction between time points,and time points between groups(P<0.05),but there was no significant difference between the two groups(P>0.05).The levels of serum amylase and lipase in two groups showed an increasing trend at 1 d and 3 d after operation,and the differences of interaction between time points and time points between groups were statistically significant(P<0.05).The levels of serum amylase and lipase in the 3-min group were lower than those in the 1-min group at 1 d and 3 d after operation(P<0.05).The incidence of pancreatitis and bleeding in the 3-min group was lower than that in the 1-min group,and the difference was statistically significant(P<0.05).The difference between the incidence of biliary tract infection in the 3-min group and the 1-min group was not statistically significant(P>0.05).Conclusion Intraoperative balloon dilation for 3 min in EST applied to elderly patients with bile duct stones can effectively reduce intraoperative bleeding,shorten the duration of operation,and effectively avoid the occurrence of pancreatitis and bleeding while ensuring the stone removal effect without affecting liver function and the degree of traumatic stress.