内镜逆行胰胆管造影取石术治疗高龄单发胆总管结石患者的效果及安全性观察

Effect and safety observation of endoscopic retrograde cholangiopancreatography in the treatment of elderly patients with single choledocholithiasis

目的探讨内镜逆行胰胆管造影(ERCP)取石术治疗高龄单发胆总管结石患者的效果及安全性。方法选取2013年3月～2017年7月我院收治的60例高龄单发胆总管结石患者作为研究对象,采用随机数字表法分为观察组和对照组,每组各30例。观察组给予ERCP取石术治疗,对照组给予腹腔镜胆总管探查取石术治疗。比较两组患者的围术期一般情况[排气时间、视觉模拟量表(VAS)评分、住院时间]、取石效果(结石残留率、6个月复发率),评估患者术前及术后1周肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转氨酶(AST)、谷氨酰基转移酶(GGT)]各指标水平,记录并比较两组患者术后并发症发生率。结果观察组排气时间、住院时间短于对照组(P<0.05),术后VAS评分低于对照组(P<0.05);两组结石残留率、6个月复发率比较,差异无统计学意义(P>0.05);术后1周,两组患者的ALT、AST、GGT水平均低于术前(P<0.05),观察组患者术后1周的ALT、AST、GGT水平低于对照组(P<0.05);两组患者的术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论 ERCP取石术与腹腔镜胆道探查取石术治疗单发胆总管结石取石效果相近,但前者在改善患者围术期情况和促进肝功能指标恢复方面更有优势。

Objective To explore the effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of elderly patients with single choledocholithiasis. Methods Sixty elderly patients with single choledocholithiasis admitted to our hospital from March 2013 to July 2017 were selected as the study subjects, they were divided into observation group and control group by random number table method, with 30 cases in each group. The observation group was treated with ERCP lithotripsy, while the control group was treated with Laparoscopic Choledocholithotomy. The general conditions of perioperative period (exhaust time, visual analogue scale [VAS] score, hospitalization time), stone removal effect (residual stone rate, recurrence rate of 6 months) were compared between the two groups, and the preoperative and postoperative 1W were evaluated. The levels of liver function (ALT, AST and GGT) were recorded and compared between the two groups. Results The exhaust time and hospitalization time in the observation group were shorter than those in the control group (P<0.05), postoperative VAS score was lower than that of control group (P<0.05). There was no significant difference in residual stone rate and recurrence rate of 6 months between the two groups (P>0.05). The levels of ALT, AST and GGT in the two groups were lower than those before operation at one week after operation (P<0.05), the levels of ALT, AST and GGT in the observation group one week after operation were lower than those in the control group (P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (P>0.05). Conclusion ERCP lithotripsy is similar to laparoscopic choledocholithotomy in the treatment of single choledocholithiasis, but the former is more advantageous in improving perioperative conditions and promoting the recovery of liver function indicators.