ESBD和EST治疗胆总管结石患者术中情况和术后炎症反应、免疫应答的比较

Comparison of intraoperative conditions and postoperative inflammatory response and immune response between patients with common bile duct stones undergoing ESBD and EST

目的:分析胆总管结石患者接受内镜下十二指肠乳头括约肌小切开联合球囊扩张术(ESBD)和内镜下十二指肠乳头括约肌切开(EST)治疗的术中情况及术后炎症反应、免疫应答的水平差异。方法:将2013年1月~2015年12月在本院接受经十二指肠镜逆行胰胆管造影(ERCP)治疗的胆总管结石患者565例纳入研究,对其治疗方法及检测结果进行回顾性分析,分为接受ESBD治疗的观察组300例,接受EST治疗的对照组265例,对比两组术中应激水平,术后炎症反应、营养相关指标及免疫应答水平差异。结果:观察组术中肾上腺素(N)、皮质醇(Cor)、C-肽(C-P)、NK细胞水平低于对照组(P<0.05),游离三碘甲状腺原氨酸(FT3)水平高于对照组(P<0.05);术后白介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)等炎症相关因子水平低于对照组,总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)等蛋白营养指标值高于对照组(P<0.05),CD4^+、CD4^+/CD8^+、IgA、IgM、IgG等免疫指标水平高于对照组(P<0.05),CD8^+水平低于对照组(P<0.05)。结论:ESBD用于胆总管结石患者的治疗,在降低手术应激、优化术后全身状态等方面均优于EST治疗。

Objective： To analyze the differences in intraoperative conditions and postoperative inflammatory response and immune response levels in patients with common bile duct stones who undergoing ESBD and EST treatment. Methods： A total of 565 patients with common bile duct stones who underwent ERCP treatment in our hospital from January 2013 to December 2015 were included in the study,patients＇ treatment and testing results were analyzed retrospectively,and then patients were divided into the observation group 300 cases that received ESBD treatment and control group 265 cases that received EST treatment. Differences in intraoperative stress levels as well as postoperative inflammation,nutrition-related index and immune response levels were compared between two groups. Results： Intraoperative N,Cor,C-P and NK cell levels of observation group were lower than those of control group,and FT3 level was higher than that of control group（ P〈0. 05）; postoperative inflammation-related factors such as IL-6,CRP,PCT,CA19-9and CEA levels were lower than those of control group,protein nutrition indexes such as TP,Alb,PA,TRF and RBP values were higher than those of control group,and immune indexes such as CD4~＋,CD4~＋/ CD8~＋,IgA,IgM and IgG levels were higher than those of control group while CD8~＋ level was lower than that of control group（ P〈0. 05）. Conclusions： ESBD for the treatment of patients with common bile duct stones is better than EST treatment in reducing surgical stress,optimizing postoperative physical status and other aspects.