探讨ERCP在消化道重建胃肠Billroth Ⅱ吻合术后胆总管结石患者中的应用价值

Explore the value of ERCP in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis

目的 探讨内镜逆行胰胆管造影(ERCP)在消化道重建胃肠BillrothⅡ吻合(胃肠毕Ⅱ式吻合)术后胆总管结石患者中的应用价值。方法 采用回顾性队列研究方法,回顾分析河北医科大学第二医院肝胆外科2015年12月—2017年11月收治的189 例胆总管结石患者行ERCP取石治疗的病例资料。根据有无消化道胃肠毕Ⅱ式吻合术病史进行分组,既往未行消化道手术的胆总管结石患者行ERCP取石治疗的为正常组(n=167),既往曾行消化道手术的患者行ERCP取石治疗的为重建组(n=22),对比两组患者的手术操作时间、取石成功率、术后并发症发生率、术后住院时间及住院费用指标。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验,偏态分布的计量资料以M(范围)表示。计数资料比较采用检验χ2检验或Fisher确切概率法。结果 消化道正常组手术操作时间为(40.18±11.80) min、ERCP取石成功率为97.60%为(163/167),重建组的手术操作时间为(61.81±13.21) min、ERCP取石成功率为81.82%(18/22),两组相比差异均有统计学意义(t=0.105, χ2=10.400,P<0.05);消化道正常组的并发症发生率为16.17%(27/167)、术后住院时间(3.47±1.55) d、住院费用(20 620.69±3 117.88) 元,重建组的并发症发生率为18.18%(4/22)、术后住院时间(4.18±2.08) d、住院费用(22 426.41±5 916.30) 元,两组相比差异无统计学意义(χ2=0.000,t=4.204,t=10.828,P>0.05)。结论 消化道重建胃肠毕Ⅱ式吻合术后胆总管结石患者行ERCP取石是安全可行的,有较高的取石成功率,创伤小,值得推广。

Objective To explore the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis.Methods A retrospective cohort study was conducted to retrospective review the data of 189 patients with choledocholithiasis treated by ERCP from December 2015 to November 2017 in Department of Hepatobiliary Surgery,Second Hospital of Hebei Medical University. According to the history of Billroth Ⅱ gastrointestinal anastomosis, the patients who have not undergone digestive surgery were divided into the normal group(n=167) and patients who have undergone digestive surgery were divided into reconstruction group (n=22). The operation time, the success rate of stone extraction, complications, the hospitalization time, total hospitalization expenses were compared between the two groups. Measurement data with normal distribution were represented as (Mean±SD) and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range).Comparisons of count data were analyzed using the χ2 test or Fisher exact probability. Results The operation time of the normal group was (40.18±11.80) min, and the success rate of ERCP was 97.60%(163/167), the operation time of reconstruction group was(61.81±13.21) min,and the success rate of ERCP was 81.82%(18/22), There were significant differences between the two groups(t=0.105, χ2=10.400,P<0.05). The complications, the hospitalization time and the total hospitalization expense of the normal group were 16.17%(27/167), (3.47±1.55) d,(20 620.69±3 117.88) yuan,the reconstruction group were 18.18%(4/22), (4.18±2.08) d, (22 426.41±5 916.30) yuan, with no statistically significant difference (χ2=0.000, t=4.204), t=10.828, P>0.05). Conclusions ERCP is safe and feasible for patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis. It also has a high success rate of stone removal and small trauma, which is worthy of promotion.