双镜联合胆总管探查术胆管自脱落支架置入与T管引流的临床疗效比较

Comparison of clinical efficacy between biliary stent placement and T-tube drainage in double endoscopy combined with common bile duct exploration

目的比较双镜(腹腔镜+胆道镜)联合胆总管探查一期缝合胆管自脱落支架置入与T管引流治疗胆囊结石合并胆总管结石的临床疗效.方法选择2015年1月~ 2017年7月因胆囊结石合并胆总管结石行双镜联合胆总管探查术的患者80例作为对象,按胆总管缝合的方式不同将其分为胆管一期缝合胆管自脱落支架置入组40例和T管引流组40例,比较两组间的手术时间、术中出血量、术后肛门排气时间、术后引流管留置时间、住院时间以及术后炎症因子肿瘤坏死因子(Tumor necrosis factor,TNF)-a,白细胞介素-6(interleukin,IL)-6、降钙素原(procalcitonin,PCT)及C反应蛋白(C-reactive protein,CRP)的变化.结果两组患者在手术时间、术中出血量、术后引流管留置时间、术后并发症的发生率的差异均无统计学意义(P>0.05).支架置入组患者的术后肛门排气时间[(24.75 ±7.58)h比(31.28±8.94)h]、术后住院时间[(9.56±0.84)d比(16.55±0.83)d]均小于T管引流组,差异具有统计学意义(P<0.05).支架置入组手术后TNF-a、IL-6、CRP及PCT水平,均低于T管引流组(P<0.05).两组患者术后的炎性指标均明显高于术前,术后72h支架植入组患者的炎性指标TNF-a(2.94±0.56) ng/mL、IL-6(16.31±4.05)ng/L、CRP(22.78 ±6.57)mg/L、PCT(5.1±1.5) ug/L均明显低于T管引流组,差异有统计学意义(P<0.05).结论双镜联合胆总管切开取石胆管一期缝合胆管自脱落支架置入能降低炎症因子水平,创伤小、恢复快、住院时间短,且不增加手术并发症的发生,值得临床推广应用.

Objective To compare the clinical efficacy of double endoscopy (laparoscopy + choledochoscopy) combined with one-stage sutured bile duct self-shedding stent implantation and T-tube drainage in the treatment of cholecystolithiasis combined with choledocholithiasis in common bile duct exploration. Methods a total of 80 cases of patients with choledocholithiasis complicated by choledocholithiasis from January 2015 to July 2017 were selected as subjects. According to the different methods of common bile duct suture, the patients were divided into 40 cases in the primary suture of bile duct with bile duct self-shedding stent implantation group and 40 cases in the T-tube drainage group. The changes in operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative drainage tube indwelling time, hospitalization time, and postoperative inflammatory factors such as Tumor necrosis factor (TNF)-a, interleukin-6 (il-6), procalcitonin ( PCT) and C-reactive protein ( CRP) were compared between the two groups. Results there were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative drainage tube in dwelling time, and postoperative complication occurrence rate (P〉0. 05). The postoperative anal exhaust time [(24. 75 ± 7. 58 ) h to (31. 28 ± 8. 94) h] and the postoperative hospitalization time [(9. 56 ± 0. 84) d to ( 16. 55 )± 0. 83 ) d] of patients in the stent implantation group were smaller than the T-tube drainage group, and the difference was statistically significant ( P < 0. 05 ). The levels of TNF-a, IL-6, CRP and PCT in the stent implantation group were lower than those in the T-tube drainage group ( P <0. 05 ). The postoperative inflammatory parameters of the two groups were significantly higher than those before operation, and 72 hours after surgery, the inflammatory parameters of TNF-a (2. 94 ±0. 56) ng/niL, IL-6 ( 16. 31 ±4. 05 ) ng / L, CRP (22. 78 ± 6. 57) mg / L and PCT (5. 1 ± 1.5) ug / L were significantly lower than the T tube drainage group, the difference was statistically significant ( P < 0. 05 ). Conclusion Double endoscopy combined with choledochotomy and primary suture of bile(kict with seif-shedding stent placement can reduce the level of inflammatory factors. It has the advantages of small trauma, quick recovery, short hospitalization time, and no increase in the incidence of surgical complications, which is worthy of clinical application.