牛磺熊去氧胆酸联合微创保胆取石术治疗胆囊结石合并胆总管结石的疗效

Efficacy of tauroursodeoxycholic acid combined with minimally invasive gallbla-dder-preserving lithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis

目的探讨牛磺熊去氧胆酸(tauroursodeoxycholicacid,TUDCA)联合微创保胆取石术治疗胆囊结石合并胆总管结石的疗效及对血清炎症因子、胆囊功能和复发的影响。方法选取100例胆囊结石合并胆总管结石患者作为研究对象,用随机数字表法分为对照组和研究组,各50例。对照组采取微创保胆取石术,研究组在对照组治疗的基础上联合TUDCA治疗,口服TUDCA 250 mg,每日2次,服用5 d后停药25 d,治疗周期为1年。对比患者的临床疗效、血清炎症因子、胆囊功能(胆囊壁厚度和胆囊收缩功能)及胆结石复发率。结果治疗后,研究组患者出现腹胀、腹泻、胆绞痛及右上腹不适的概率明显低于对照组(P<0.05);研究组的复发率(2.00%)明显低于对照组(20.00%),P<0.05;研究组的总有效率(96.00%)高于对照组(76.00%),P<0.05;研究组的胆囊壁厚度[(2.48±0.31)mm]明显小于对照组[(3.87±0.65)mm],P<0.05;研究组胆囊收缩比明显高于对照组(P<0.05);研究组的肿瘤坏死因子-α(transforming growth factor-α,TNF-α)、白细胞介素(Interleukin,IL)-6和IL-8水平均显著低于对照组(P<0.05);研究组的IL-10水平显著高于对照组(P<0.05)。结论TUDCA联合微创保胆取石术治疗胆囊结石合并胆总管结石能显著缓解患者的临床症状并降低复发率,获得更有效的临床治疗效果,对促进胆囊功能恢复、缓解炎症反应有显著的作用。

Objective To investigate the efficacy of taurocursodeoxycholic acid(TUDCA)combined with minimally invasive gallbladder-preserving lithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis,and the influence on serum inflammatory factors,gallbladder function and recurrence.Methods A total of 100 patients with cholecystolithiasis and choledocholithiasis were enrolled and divided into control group and study group by random number table method,with 50 cases in each group.The control group was treated with minimally invasive gallbladder-preserving lithotomy,and the study group was treated with TUDCA on the basis of control group.The clinical efficacy,serum inflammatory factors,gallbladder function(gallbladder wall thickness and gallbladder contraction function),and the recurrence rate of cholecystolithiasis of the 2groups were compared.Results The incidence rates of abdominal distension,diarrhea,biliary colic,and discomfort in upper right abdomen in the study group were significantly lower than those in the control group(P<0.05).The recurrence rate in the study group after treatment(2.00%)was significantly lower than that in the control group(20.00%)(P<0.05).The total clinical response rate in the study group(96.00%)was significantly higher than that in the control group(76.00%)(P<0.05).After treatment,the gallbladder wall thickness in the study group[(2.48±0.31)mm]was significantly smaller than that in the control group[(3.87±0.65)mm](P<0.05).The gallbladder contraction ratio in the study group was significantly higher than that in the control group(P<0.05).The levels of transforming growth factor-α(TNF-α),interleukin(IL)-6 and IL-8 in the study group were significantly lower than those in the control group(P<0.05).The level of IL-10 in the study group was significantly higher than that in the control group(P<0.05).Conclusion TUDCA combined with minimally invasive gallbladder-preserving lithotomy can significantly alleviate clinical symptoms and reduce recurrence rate in patients with cholecystolithiasis and choledocholithiasis.In addition,the combined treatment can significantly promote gallbladder function recovery and alleviate inflammatory reactions.It is worthy of promotion and application in clinical practice.