胆总管结石继发急性重症胆管炎患者行内镜下逆行胆胰管造影术治疗的效果分析

Analysis of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Patients with Choledochal Stones Secondary to Acute Severe Cholangitis

目的:分析胆总管结石继发急性重症胆管炎患者行内镜下逆行胆胰管造影术(ERCP)治疗的效果。方法:选取2023年2月—2024年2月遵义市桐梓县人民医院收治的胆总管结石继发急性重症胆管炎患者60例为研究对象,随机分为对照组与研究组,各30例。对照组行腹腔镜下胆总管探查取石术治疗,研究组行ERCP治疗。比较两组时间指标、炎性指标及肝胆生化指标水平、并发症发生情况。结果:研究组手术时间及住院时间短于对照组,腹痛缓解时间、发热缓解时间、寒战缓解时间、黄疸消退时间早于对照组,差异有统计学意义(P<0.05)。术后3d,两组白细胞计数、中性粒细胞比例、血清高迁移率族蛋白B1水平降低,研究组低于对照组,差异有统计学意义(P<0.05)。术后,两组总胆红素(TBiL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平低于治疗前,差异有统计学意义(P<0.05);两组TBiL、ALT、AST水平比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:ERCP治疗胆总管结石继发急性重症胆管炎的效果显著,可缩短手术时间,加快恢复速度,减轻炎症,改善肝胆功能,且不会增加并发症发生率。

Objective:To analyze the effect of endoscopic retrograde cholangiopancreatography(ERCP)in patients with choledochal stones secondary to acute severe cholangitis.Methods:Sixty patients with choledochal stones secondary to acute severe cholangitis admitted to Zunyi Tongzi County People's Hospital from February 2023 to February 2024 were selected as the study subjects,and were randomly divided into the control group and the study group,each with thirty cases.The control group was treated with laparoscopic choledochotomy and lithotripsy,and the study group was treated with ERCP.Time indexes,inflammation indexes and liver and gallbladder biochemical index levels,and the occurrence of complications were compared between the two groups.Results:The operation time and hospitalization time of the study group were shorter than that of the control group,and the time of abdominal pain relief,fever relief,chills relief,and jaundice subsiding time were earlier than that of the control group,and the difference was statistically significant(P<0.05).At 3 d postoperatively,the leukocyte count,neutrophil ratio,and serum high mobility group protein B1 level decreased in both groups,and the study group was lower than the control group,and the difference was statistically significant(P<0.05).After surgery,the levels of total bilirubin(TBiL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)were lower than those before treatment in the two groups,and the difference was statistically significant(P<0.05);comparing the levels of TBiL,ALT,and AST in the two groups,the difference was not statistically significant(P>0.05).Comparison of complication rates between the two groups,the difference was not statistically significant(P>0.05).Conclusion:ERCP is effective in the treatment of choledochal stones secondary to acute severe cholangitis,which can shorten the operation time,accelerate the recovery speed,reduce the inflammation,improve the hepatobiliary function,and will not increase the complication rate.