双镜联合治疗急性胆源性胰腺炎合并胆囊结石的临床疗效

Therapeutic effect of combined treatment for acute biliary pancreatitis with cholecystolithiasis

目的探讨双镜联合治疗急性胆源性胰腺炎合并胆囊结石患者的临床疗效,及其对淀粉酶(AMS)、高敏C反应蛋白(hs-CRP)、巨噬细胞炎症蛋白-1β(MIP-1β)和氧化应激反应的影响。方法选取2017年1月-2021年12月该院收治的急性胆源性胰腺炎伴胆囊结石患者102例,按不同手术方式分为双镜组(63例)和开腹组(39例),双镜组行双镜联合(腹腔镜和胆道镜)治疗,开腹组行开腹胆囊切除联合胆总管取石治疗,比较两组患者恢复指标、临床疗效、疼痛视觉模拟评分法(VAS)、MIP-1β、hs-CRP、AMS、氧化应激反应指标和并发症发生率。结果双镜组术中出血量少于开腹组,肛门排气时间、腹部症状缓解时间和住院时间短于开腹组,总有效率高于开腹组,差异均有统计学意义(P<0.05)。重复测量数据方差分析结果显示,两组患者VAS的时点、组间和交互效应比较,差异均有统计学意义(P<0.05);两组患者术后1和7 d的VAS较术前降低,且双镜组低于开腹组,差异均有统计学意义(P<0.05)。两组患者术后7 d的MIP-1β、hs-CRP和AMS较术前降低,且双镜组低于开腹组,差异均有统计学意义(P<0.05)。双镜组术后7 d的超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPPs)、丙二醇(MDA)和谷胱甘肽过氧化物酶(GSH-Px)与术前比较,差异均无统计学意义(P>0.05);但双镜组术后7 d的SOD和GSH-Px高于开腹组,AOPPs和MDA低于开腹组,差异均有统计学意义(P<0.05)。双镜组并发症总发生率低于开腹组(4.76%和25.64%),差异有统计学意义(P<0.05)。结论对于急性胆源性胰腺炎伴胆囊结石患者来说,经双镜联合治疗后,能获得比较理想的临床效果,可有效缓解术后疼痛,改善血清MIP-1β、hs-CRP和AMS指标,调节氧化应激反应,减少术后并发症发生风险,促进术后恢复。

Objective To investigate the clinical efficacy of combined double-mirror treatment of patients with acute biliary pancreatitis combined with cholecystolithiasis and its effects on amylase(AMS),high-sensitivity Creactive protein(hs-CRP),macrophage inflammatory protein-1β(MIP-1β)and oxidative stress.Methods 102 patients with acute biliary pancreatitis with cholecystolithiasis from January 2017 to December 2021 were selected and divided into the double-mirror group(63 cases)and the open group(39 cases)according to different surgical modalities;the double-mirror group underwent double mirror combination(laparoscope and choledochoscope)treatment,and the open group underwent open cholecystectomy combined with choledochotomy for lithotripsy,and the two groups were compared for the recovery indexes and clinical efficacy,pain visual analogue scale(VAS),MIP-1β,hs-CRP,AMS,oxidative stress indicators and complication rate.Results Intraoperative bleeding was less than that of the open group in the double-mirror group,anal defecation time,abdominal symptom relief time and hospitalization time were shorter than those of the open group,and the overall effective rate was higher than that of the open group,and the differences were all statistically significant(P<0.05).Repeated-measures ANOVA results showed that the time-point,between-group and interaction effects of VAS in the two groups were compared,and the differences were statistically significant(P<0.05);the VAS of patients in the two groups at 1 and 7 d postoperatively was lower than that of preoperative,and it was lower in the double-mirror group than that of the open group,and the differences were all statistically significant(P<0.05).The MIP-1β,hs-CRP and AMS of patients in both groups at 7 d postoperatively were lower than those of preoperative,and the double-mirror group was lower than that of the open group,and the differences were statistically significant(P<0.05).Superoxide dismutase(SOD),advanced oxidized protein products(AOPPs),malonaldehyde(MDA)and glutathione peroxidase(GSH-Px)in the double-mirror group were not statistically significant at 7 d postoperatively compared with those in the preoperative group(P>0.05);however,SOD and GSH-Px were higher than those of the open group in the double-mirror group at 7 d postoperatively,and AOPPs and MDA were lower than those of the open group,and the differences were all statistically significant(P<0.05).The total complication rate of double-mirror group was lower than that of open group(4.76%and 25.64%),and the difference was statistically significant(P<0.05).Conclusion For patients with acute biliary pancreatitis with cholecystolithiasis,double-mirror combined treatment can achieve ideal clinical results,effectively relieve postoperative pain,improve serum MIP-1β,hs-CRP and AMS indexes,regulate oxidative stress,reduce the risk of postoperative complications and promote postoperative recovery.