胆囊穿刺双置管引流联合胆道镜治疗高危结石性胆囊炎临床效果观察

Application of Ultrasound Guided Double Catheters PGCD Combined with Choledochoscopy in Treatment of Patients with High-risk Gallstone Cholecystitis

目的:探讨超声引导下经皮胆囊穿刺双管引流联合胆道镜在高危结石性胆囊炎患者中的应用效果及对血清肿瘤坏死因子-α(TNF-α)、瘦素水平的影响。方法:选取收治的高危结石性胆囊炎患者110例,随机数字表法分为对照组(n=55)和观察组(n=55)。对照组采用传统开腹手术治疗,观察组采用超声引导下经皮胆囊穿刺双管引流联合胆道镜治疗,采用酶联免疫吸附试验测定两组治疗前、后血清TNF-α、瘦素水平,比较两组临床疗效及对血清TNF-α、瘦素水平的影响。结果:两组术前血清TNF-α、瘦素水平比较差异无统计学意义(P>0.05);观察组出院前血清TNF-α为(41.2±5.5)ng/L、瘦素为(4.5±1.2)ng/L,均低于对照组[分别为(58.6±7.2)ng/L、(6.9±1.4)ng/L,P<0.05];观察组术后并发症发生率为3.6%,对照组为10.9%,二者比较差异有统计学意义(P<0.05)。结论:超声引导下经皮胆囊穿刺双置管引流联合胆道镜治疗高危结石性胆囊炎患者疗效确切,同时能降低血清TNF-α、瘦素水平。

Objective To evaluate the application of ultrasound guided double catheters percutaneous gallbladder catheterized drainage(PGCD)combined with choledochoscopy in patients with high risk gallstone cholecystitis,and observe the levels of TNF-αand leptin in serum.Methods Totally 110 patients with high-risk gallstone cholecystitis were elected.According to a computer-generated list of random numbers,all patients were randomly assigned to a control group(n=55)and an observation group(n=55).In control group,patients were treated by cholecystectomy.In observation group,the ultrasound guided double catheters PGCD combined with choledochoscopy were applied.In two groups,enzyme-linked immunosorbent assay(ELISA)were used to detect the the levels of TNF-αand leptin in serum before and after treatment.The therapeutic effectiveness and the levels of TNF-αand leptin in serum were compared between the two groups.Results There was no difference in the serum levels of TNF-αand leptin between the two groups before treatment(P>0.05).Before discharge,the serum levels of TNF-αand leptin were significantly lower in observation group[TNF-α(41.2±5.5)ng/L,leptin(4.5±1.2)μg/L]than in control group[TNF-α(58.6±7.2)ng/L,leptin(6.9±1.4)μg/L],the difference was significant(P<0.05).Compared the percentages of postoperative complications in observation group(3.6%)than control group(10.9%),the difference was significant(P<0.05).Conclusion The therapeutic effectiveness were obvious when the ultrasound guided double catheters PGCD combined with choledochoscopy was apply to treat patients with high-risk gallstone cholecystitis,and the treatment decreasd the levels of TNF-αand leptin in serum.