双镜联合治疗急性胆源性胰腺炎伴胆总管结石疗效及对患者降钙素原、超敏C-反应蛋白、血淀粉酶及氧化应激反应的影响

Efficacy of laparoscope combined with choledochoscope in treatment of acute biliary pancreatitis complicated with choledocholithiasis and the influence on PCT,hs-CRP,AMS and oxidative stress

目的:探讨腹腔镜、胆道镜双镜联合治疗急性胆源性胰腺炎(ABP)伴胆总管结石的疗效及对患者降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、血淀粉酶(AMS)及氧化应激反应的影响。方法:将72例ABP伴胆总管结石患者,随机分为开腹组(n=32)和双镜组(n=40),开腹组给予开腹胆囊切除及胆总管取石治疗,双镜组给予腹腔镜胆囊切除与胆道镜取石联合治疗,比较两组临床疗效、手术相关指标,治疗前后血清PCT、hs-CRP、AMS水平,以及氧化应激指标[丙二醛(MDA)、晚期蛋白氧化产物(AOPPs)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)],统计两组患者术后并发症发生情况。结果:双镜组患者术中失血量少于开腹组,术后住院时间、肛门排气时间短于开腹组(均P<0.05),两组患者手术时间比较差异无统计学意义(P>0.05);术前两组患者血清PCT、hs-CRP、AMS水平比较无统计学差异(均P>0.05),术后7 d两组患者上述血清指标均下降,且双镜组低于开腹组(均P<0.05);双镜组术前术后血清MDA、AOPPs、GSH-Px、SOD水平比较无统计学差异(均P>0.05),开腹组血清MDA、AOPPs水平较术前均升高,GSH-Px、SOD水平较术前均下降(均P<0.05);双镜组术后并发症发生率(2.50%)低于开腹组(15.63%)(P<0.05)。结论:相较于开腹手术,双镜联合治疗ABP伴胆总管结石疗效显著,可减少失血量,促进术后恢复,降低PCT、hs-CRP、AMS水平,术后应激反应小,且安全性良好。

Objective:To investigate the efficacy of laparoscope combined with choledochoscope in the treatment of acute biliary pancreatitis(ABP)complicated with choledocholithiasis,and the influence on procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),blood amylase(AMS)and oxidative stress.Methods:A total of 72 patients with ABP and choledocholithiasis were randomly divided into laparotomy group(32 cases)and double-endoscope group(40 cases).Patients in the laparotomy group were treated with laparotomy cholecystectomy and choledocholithotomy,while those in the double-endoscope group were treated with laparoscopic cholecystectomy and choledochoscopic stone extraction.Clinical effects,operation-related indicators,serum PCT,hs-CRP and AMS levels,and oxidative stress indicators[malondialdehyde(MDA),advanced oxidative protein products(AOPPs),glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)]were compared between two groups.The incidence of postoperative complications was calculated.Results:The intraoperative blood loss in the double-endoscope group was less than that in the laparotomy group,and the postoperative hospital stay and anal exhaust time were shorter than that in the laparotomy group(all P<0.05).There was no significant difference in the operation time between the two groups(P>0.05).Serum PCT,hs-CRP and AMS levels showed no significant difference between two groups before operation(all P>0.05).On day 7 after operation,the levels of serum PCT,hs-CRP and AMS decreased,and the double-endoscope group was lower than the laparotomy group(all P<0.05).Serum MDA,AOPPs,GSH-Px and SOD levels in the double-endoscope group showed no significant difference before and after operation(all P>0.05).In the laparotomy group,serum MDA and AOPPs levels increased,GSH-Px and SOD levels decreased after operation(all P<0.05).The incidence of postoperative complications in the double-endoscope groupwas lower than that in the laparotomy group(2.50%vs.15.63%,P<0.05).Conclusion:Compared with laparotomy,combined endoscopic treatment is more effective in the treatment of ABP complicated with choledocholithiasis.The combined treatment can reduce blood loss,promote postoperative recovery,and lower the levels of PCT,hs-CRP and AMS,with mild postoperative stress response and good safety.