经内镜逆行性胰胆管造影取石术与传统术式治疗胰管结石的临床疗效比较

Clinical efficacy comparison of endoscopic retrograde cholangiopancreatography and conventional surgery for pancreatic ductal stones

目的比较经内镜逆行性胰胆管造影(ERCP)取石术与传统术式在胰管结石治疗中的临床疗效。方法回顾性分析2017年11月至2022年11月间湖南师范大学附属岳阳医院和中南大学湘雅三医院住院的47例慢性胰腺炎合并胰管结石患者的临床资料,按结石手术治疗方式分为ERCP组(19例)、腹腔镜组(10例)和开腹组(18例),比较3组患者的一般临床特征、手术及术后恢复指标、疼痛程度分级、一期结石清除率、并发症发生率及胰腺功能评价等指标。结果3组患者的年龄、性别、体重指数、病因、病程、症状(腹痛、腹泻)、结石部位、结石大小、术前肿瘤标志物(CEA、AFP、CA19-9)及血清炎症因子(CRP)水平差异均无统计学意义。ERCP组手术时间(1.47±0.51)h、术后首次排气时间(1.16±0.20)d、引流管拔除时间(8.68±3.30)d、住院时间(11.37±4.59)d及术中失血量(109.5±16.5)ml、术后第1天CRP(11.24±2.62)mg/L、治疗费用(35238±10663)元均短于或低于腹腔镜组、开腹组;腹腔镜组术后首次排气时间(2.40±0.70)d、引流管拔除时间(12.10±5.36)d及术中失血量(195.0±83.2)ml、术后第1天CRP(14.52±3.62)mg/L及治疗费用(69908±11310)元均短于或低于开腹组,差异均有统计学意义(P值均<0.05)。ERCP组中、重度疼痛者(10.53%)低于腹腔镜组(70.00%)、开腹组(83.38%),差异有统计学意义(P值均<0.05)。ERCP组一期结石清除率及并发症发生率、术后糖化血红蛋白水平与腹腔镜组、开腹组比较差异无统计学意义,但患者体重下降(26.32%)、腹泻发生率(21.05%)较腹腔镜组、开腹组低,差异有统计学意义(P值均<0.05)。结论ERCP取石术是一种有效、安全、微创、经济的治疗胰管结石的方法,适合于多数胰管结石患者,但对于结石嵌顿或复杂胰管结石的患者,应根据实际情况选择腹腔镜或开腹手术治疗。

Objective To compare the clinical efficacy of transendoscopic retrograde cholangiopancreatography(ERCP)lithotripsy with that of traditional surgical procedures in the treatment of pancreatic ductal stones.Methods The clinical data of 47 patients with chronic pancreatitis combined with pancreatic duct stones hospitalized in Yueyang Hospital affiliated to Hunan Normal University and Third Xiangya Hospital of Central South University between November 2017 and November 2022 were retrospectively analyzed.All the patients were divided into ERCP group(n=19),laparoscopic group(n=10)and open abdominal group(n=18)according to the mode of surgical treatment for pancreatic stone,and the general clinical characteristics,the surgical and postoperative recovery indicators,pain level grading,one-stage stone removal rate,complication rate and evaluation of pancreatic function were compared among the three groups.Results The age,gender,body mass index,etiology,duration of disease,symptoms(abdominal pain,diarrhea),stone location,stone size,preoperative tumor markers(CEA,AFP,CA19-9)and serum inflammatory factor(CRP)level were not statistically significant among three groups.In ERCP group,the operation time(1.47±0.51)h,the time of the first postoperative intestinal ventilation(1.16±0.20)days,the time of drainage removal(8.68±3.30)days,the length of hospitalization(11.37±4.59)days and intraoperative blood loss(109.5±16.5)ml,the CRP on the first postoperative day(11.24±2.62)mg/L,and the treatment cost(35238±10663)were obviously shorter or lower than those of laparoscopic and open abdominal group;in the laparoscopic group,the time to first postoperative bowel ventilation(2.40±0.70)days,drainage removal time(12.10±5.36)days and intraoperative blood loss(195.0±83.2)ml,postoperative CRP on day one(14.52±3.62)mg/L,and the treatment cost(69908±11310)were greatly shorter or lower than those in open abdominal group;and all the differences were statistically significant(all P value<0.05).Those with moderate and severe pain in ERCP group(10.53%)were lower than those in laparoscopic group(70.00%)and open abdominal group(83.38%),and the difference was statistically significant(all P value<0.05).There was no statistically significant difference between ERCP group and laparoscopic and open abdominal group in terms of phase I stone removal rate,complication rate,and postoperative glycated haemoglobin level,but patients'weight loss(26.32%)and incidence of diarrhea(21.05%)were lower than those of laparoscopic and open abdominal group,and all the difference was statistically significant(all P value<0.05).Conclusions ERCP lithotripsy is an effective,safe,minimally invasive and economical treatment for pancreatic duct stone and is suitable for most patients with pancreatic duct stone,but patients with embedded or complex pancreatic duct stones should be treated with laparoscopic or open abdominal surgery according to the actual situation.