硬镜联合鞘管经T管窦道治疗胆管结石后胆汁中炎性介质水平的临床研究

Clinical study on the biliary inflammatory mediators after choledocholithiasis treated by hard-mirror combined with sheath tube via T-tube sinus

目的探讨分析分别用硬镜联合鞘管与纤维胆道镜经T管窦道治疗胆管残留结石术后胆汁中炎性介质变化水平及对临床疗效的影响。方法 76例胆石症术后胆管残留结石患者随机分为实验组和对照组,分别行硬质胆道镜联合鞘管经T管窦道取石术治疗,及纤维胆道镜经T管窦道取石术治疗,比较分析两组患者手术0 h、术后8 h、24 h、48 h、72 h胆汁中PCT、,TNF-a水平及变化趋势;结果两组患者胆汁中的TNF-a、PCT水平0 h时无统计学差异,术后8 h开始上升,24 h达到最高峰,24后开始下降,观察组患者术后72 h胆汁中TNF-a、PCT水平下降到正常值范围内,进一步分析观察组患者术后8 h、24h、48 h、72 h胆汁中的TNF-a、PCT水平均低于对照组患者,差异均具有统计学意义(P<0.05)。结论硬质胆道镜联合鞘管经T管窦道取石术术后胆汁中PCT、TNF-a水平升高的程度更低,下降的速率更快,说明对胆管的炎性刺激更小,同时反映硬质胆道镜联合鞘管经T管窦道治疗胆道残留结石手术时间短、取石效率高、患者炎性反应小、手术耐受性好,值得推广。

Objective To analyze the changes of inflammatory mediators in bile after treatment of cholangiocarcinoma with choledochoscopy and choledochofiberscope combined with choledochofiberscope. Methods To divide Seventy-six patients with residu- al bile duct stones after cholelithiasis were randomly divided into experimental group and control group. The choledochoscopy combined with the sheath was performed by T-tube sinus calculus and the choledochofiberscope were treated by T-tube sinus calculus. The levels of PCT and TNF-a in bile were analyzed and compared between the two groups at 0 h, 8 h, 24 h, 48 h and 72 h after operation. Re- suits The levels of TNF-a and PCT in the bile of the two groups had no statistical significance at 0 h, and began to increase at 8 h, peaked at 24 h, then began to decrease after 24 h. The levels of TNF-a, PCT in the bile of the observation group （P 〈 0. 05 ）. The level of TNF-a and PCT in the bile of the observation group was lower than that in the control group at 8 h, 24 h, 48 h and 72 h after operation （P 〈 0. 05 ）. Conclusion The level of PCT and TNF-a in the choledochofiberscope combined with the sheath tube after T- tube sinus lithotripsy was lower and the rate of descent was faster, indicating that the bile duct inflammatory stimulation was smaller, Reflect the combination of rigid choledochoscopy combined with T tube sinus treatment of biliary residual calculus operation time is short, stone extraction efficiency, patients with small inflammatory response, surgical tolerability, and worthy of further clinical promo- tion.