内镜逆行胰胆管造影术联合钬激光碎石治疗难治性胆总管结石的疗效

Application of holmium laser lithotripsy combined with endoscopic retrograde cholangiopancreatography in refractory common bile duct stones

目的观察难治性胆总管结石(CBDS)患者采用钬激光碎石、经内镜逆行胰胆管造影术联合治疗的临床效果。方法选取2019年6月至2021年5月石家庄市第三医院收治的85例难治性CBDS患者,依据手术方法的不同分为研究组(钬激光碎石+经内镜逆行胰胆管造影术治疗)44例和对照组(胆总管切开取石外科手术治疗)41例。对比两组患者手术相关指标、取石成功率、炎性因子水平及并发症发生情况。结果研究组手术时间[(35.28±10.15)min比(102.57±34.56)min]、术后卧床时间[(1.58±0.37)d比(3.86±0.73)d]及住院时间[(6.41±0.52)d比(11.85±2.76)d]均短于对照组(t=12.361、18.347、12.837,均P<0.01)。研究组取石成功率与对照组相近(97.73%比95.12%)(χ^(2)=0.423、P=0.515)。研究组术后IL-1β[(6.48±0.81)比(25.46±4.83)ng/mL]、IL-6[(4.73±1.15)比(13.75±2.86)ng/mL]及TNF-α[(2.56±0.46)比(6.85±0.76)μg/mL]水平均低于对照组(t=25.639、19.318、31.729,均P<0.01)。研究组并发症总发生率为低于对照组(4.55%比21.95%)(χ^(2)=5.707、P=0.017)。结论钬激光碎石、经内镜逆行胰胆管造影术联合治疗难治性CBDS患者效果较好。

Objective To observe the clinical effect of combined holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography in patients with refractory common bile duct stones(CBDS).Methods A total of 85 patients with refractory CBDS who were admitted to the Third Hospital of Shijiazhuang City(June 2019 to May 2021)were selected and divided into study groups(holmium laser lithotripsy+endoscopic retrograde cholangiopancreatography)according to different surgical methods.treatment,44 cases and control group(surgical treatment of choledocholithotomy,41 cases).The operation-related indicators,stone removal success rate,inflammatory factor levels and complications were compared between the two groups.Results The operation time of the study group[(35.28±10.15)vs(102.57±34.56)min],postoperative bed time[(1.58±0.37)vs(3.86±0.73)d]and hospital stay[(6.41±0.52)vs(11.85)±2.76d]were shorter(t=12.361,18.347,12.837,all P<0.001).The success rate of stone removal in the study group(97.73%vs 95.12%)was similar(χ^(2)=0.423,P=0.515).The postoperative IL-1β[(6.48±0.81)vs(25.46±4.83)ng/mL],IL-6[(4.73±1.15)vs(13.75±2.86)ng/mL]and TNF-α[(2.56±0.46)vs(6.85±0.76)μg/mL]levels were lower(t=25.639,19.318,31.729,all P<0.001).The total incidence of complications in the study group(4.55%vs 21.95%)was lower(χ^(2)=5.707,P=0.017).Conclusion The combination of holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography is effective in the treatment of refractory CBDS patients.