乳头夹闭成型+胆总管取石术治疗胆总管结石伴急性胆管炎的应用体会

Application of papilla clipping and plasty combined with choledocholithotomy in the treatment of choledocholithiasis with acute cholangitis

目的:探讨内镜下乳头夹闭成型术联合胆总管取石术治疗胆总管结石伴急性胆管炎的疗效及应用价值。方法:选取2021年1月至2022年3月收治的102例胆总管结石伴急性胆管炎患者,采用随机数字表法分为两组,每组51例。对照组行常规胆总管取石术,观察组在此基础上行内镜下乳头夹闭成型术。观察两组手术相关指标、手术前后肝功能(谷草转氨酶、谷丙转氨酶、总胆红素)、炎症应激指标(髓过氧化物酶、白介素-1、白介素-6、CD64分子)、Oddi括约肌功能、并发症及结石复发情况。结果:两组术中出血量、手术时间、术后首次排气时间、住院时间差异无统计学意义(P>0.05);术后第1天、第3天、第5天,两组血清谷丙转氨酶、谷草转氨酶、总胆红素水平差异无统计学意义(P>0.05),观察组血清髓过氧化物酶、白介素-1、白介素-6、CD64分子水平低于对照组,差异有统计学意义(P<0.05);术后2个月,观察组括约肌基础压力、时相性收缩幅度、时相性收缩频率高于对照组,差异有统计学意义(P<0.05)。观察组与对照组并发症发生率差异无统计学意义(27.45%vs. 39.22%,P>0.05);随访2年,观察组与对照组结石复发率差异无统计学意义(4.17%vs. 12.24%,P>0.05)。结论:内镜下乳头夹闭成型术辅助常规胆总管取石术可减轻胆总管结石伴急性胆管炎患者的炎症应激反应,促进Oddi括约肌功能早期恢复,且不会增加并发症的发生风险。

Objective:To investigate the therapeutic effect and application value of endoscopic papillary clipping and plasty combined with choledocholithotomy in treatment of acute cholangitis and choledocholithiasis.Methods:A total of 102 patients with c holedocholithiasis accompanied by acute cholangitis from Jan.2021 to Mar.2022 were selected and randomly divided into two groups using a random number table method,with 51 cases in each group.The control group underwent conventional choledocholithotomy,while the observation group underwent endoscopic papillary clipping and plasty on the base of control group.The surgical-related indicators,complications,and calculus recurrence in both groups were observed,as well as liver function(aspartate aminotransferase,alanine aminotransferase,total bilirubin),inflammatory stress indicators(myeloperoxidase,interleukin-1,interleukin-6,CD64 molecule),and Oddi sphincter function before and after surgery.Results:There was no significant difference in the intraoperative blood loss,duration of surgery,postoperative first exhaust time and hospital stay between the two groups(P>0.05).There was no significant difference in the le-vels of serum alanine aminotransferase,aspartate aminotransferase,and total bilirubin between the two groups on postoperative day 1,3,and 5(P>0.05).The levels of serum myeloperoxidase,interleukin-1,interleukin-6,and CD64 molecules in the observation group were lower than those in the control group on postoperative day 1,3,and 5,and the difference was statistically significant(P<0.05).Two months after surgery,the basal pressure,phase-specific contraction amplitude,and phase-specific contraction frequency of the sphincter in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between observation group and control group(27.45%vs.39.22%,P>0.05).During the 2-year follow-up,the recurrence rate of calculi in the observation group was 4.17%,which was not significantly di-fferent from the control group's 12.24%(P>0.05).Conclusions:Endoscopic papillary clipping and shaping assisted-conventional choledocholithotomy can reduce inflammatory stress response in patients with choledocholithiasis accompanied by acute cholangitis,promote early recovery of Oddi sphincter function,and does not increase the risk of complications.