经内镜逆行胰胆管造影联合腹腔镜手术对胆总管结石伴胆囊结石临床疗效及相关炎症因子、血清尿胰蛋白酶原-2的影响
发布时间：2018-08-02 18:41
【摘要】：目的观察经内镜逆行胰胆管造影(ERCP)联合腹腔镜手术在胆总管结石伴胆囊结石患者中的应用价值以及该手术方式对患者临床疗效、相关炎症因子及血清尿胰蛋白酶原-2水平的影响。方法选取我院2014年6月至2016年5月收治的184例胆总管结石伴胆囊结石患者作为研究对象,按照随机数字表法将其分成两组,每组92例。其中观察组给予ERCP联合腹腔镜手术治疗,对照组给予传统开腹探查手术治疗,采用χ2检验比较两组患者的手术疗效及并发症情况;采用t检验比较两组手术时间、术中出血量等手术相关指标;采用F检验/t检验比较两组手术前后不同时点血清白细胞介素(IL)-1、IL-6、C反应蛋白(CRP)水平以及血清尿胰蛋白酶原-2水平。结果观察组一期结石清除90例,清除率97.83%,对照组一期结石清除89例,清除率96.74%,两组一期结石清除率比较差异无统计学意义(χ2=0.21,P0.05);观察组二期结石清除92例,清除率100%,对照组二期结石清除92例,清除率100%,两组二期结石清除率比较差异无统计学意义(χ~2=0.00,P0.05);观察组手术时间为(122.36±18.75)min,对照组为(118.24±14.52)min,两组比较差异无统计学意义(t=1.67,P0.05);观察组术中出血量(25.35±5.64)ml,明显少于对照组(84.16±7.75)ml(t=58.85,P0.01);观察组肛门排气时间(1.19±0.46)d,明显短于对照组(2.58±0.73)d(t=15.45,P0.01);观察组住院时间(7.18±2.34)d,明显短于对照组(14.67±4.13)d(t=15.13,P0.01);观察组并发症发生率为2.17%,相对于对照组的10.87%明显下降(χ~2=5.71,P0.05);观察组术后3 h、1 d、3 d时IL-1水平分别为(23.78±8.84)μg/L、(36.78±5.36)μg/L、(6.64±1.65)μg/L,对照组分别为(55.63±13.35)μg/L、(121.35±26.34)μg/L、(18.24±17.86)μg/L,观察组各时点血清IL-1水平均明显低于对照组(t=19.08、30.18、6.20,P0.01);观察组术后3 h、1 d、3 d时IL-6水平分别为(17.53±6.34)μg/L、(31.24±5.87)μg/L、(2.56±1.24)μg/L,对照组分别为(48.46±12.78)μg/L、(112.56±24.63)μg/L、(17.24±12.45)μg/L,观察组各时点血清IL-6水平均明显低于对照组(t值分别为20.80、30.81、11.25,P0.01);观察组术后3 h、1 d、3 d时CRP水平分别为(236.78±43.56)μg/L、(445.67±53.67)μg/L、(59.42±28.34)μg/L,对照组分别为(392.66±65.35)μg/L、(995.25±86.25)μg/L、(158.37±75.24)μg/L,观察组各时点血清CRP水平均明显低于对照组(t=19.04、51.89、11.80,P0.01);观察组组术后3 h、1 d、3 d时血清尿胰蛋白酶原-2水平分别为(37.12±5.12)ng/ml、(35.99±4.97)ng/ml、(35.84±4.13)ng/ml,对照组分别为(36.67±5.34)ng/ml、(36.12±4.75)ng/ml、(36.03±4.61)ng/ml,两组各时点比较差异无统计学意义(t值分别为0.58、0.18、0.29,P0.05)。结论 ERCP联合腹腔镜手术作为一种微创手术方案对胆总管结石伴胆囊结石患者具有较好的临床疗效,且术后炎症反应轻,不良并发症少,值得临床推广。
[Abstract]:Objective to observe the value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic surgery in patients with choledocholithiasis and cholecystolithiasis. Effects of related inflammatory factors and serum levels of urinary trypsinogen-2. Methods 184 cases of choledocholithiasis with cholecystolithiasis treated in our hospital from June 2014 to May 2016 were selected and divided into two groups according to random digital table, 92 cases in each group. The observation group was treated with ERCP combined with laparoscopic surgery, the control group was treated with traditional open exploration surgery, the two groups were treated with 蠂 2 test, the operative effect and complications were compared by 蠂 2 test, and the operation time was compared by t test. The serum levels of interleukin (IL) -1 and IL-6 / C reactive protein (CRP) and urinary trypsinogen 2 (urinary trypsinogen 2) were compared between the two groups at different time points before and after operation by F / t test. Results there were 90 cases of primary stone removal in the observation group and 97.83 cases in the control group, 89 cases in the control group, with a clearance rate of 96.744.There was no significant difference between the two groups in the primary stone clearance rate (蠂 2 + 0.21 P 0.05), 92 cases in the observation group, 92 cases in the observation group, and 92 cases in the control group. The clearance rate was 100 and 92 cases in the control group. There was no significant difference between the two groups in the clearance rate of secondary stones (蠂 2 + 0.005), the operative time in the observation group was (122.36 卤18.75) minutes, the control group was (118.24 卤14.52) minutes, the difference between the two groups was not significant (P0.05), the intraoperative bleeding volume in the observation group was (25.35 卤5.64) ml, which was significantly lower than that in the control group (84.16 卤7.75) ml (/ t 58.85 P0.01). The anal exhaust time in the observation group was (1.19 卤0.46) days, significantly shorter than that in the control group (2.58 卤0.73) d (/ t 15.45, P 0.01), the hospitalization time in the observation group was (7.18 卤2.34) days, which was significantly shorter than that in the control group (14.67 卤4.13) d (/ t 15.13, P 0.01), the incidence of complications in the observation group was 2.17, which was significantly lower than that in the control group (10.87%, P 0.05), and the IL-1 level in the observation group was significantly lower than that in the control group at 3 hours and 1 day after operation (P < 0.05). 鍒负(23.78卤8.84)渭g/L,(36.78卤5.36)渭g/L,(6.64卤1.65)渭g/L,瀵圭収缁勫垎鍒负(55.63卤13.35)渭g/L,(121.35卤26.34)渭g/L,(18.24卤17.86)渭g/L,瑙傚療缁勫悇鏃剁偣琛，
本文编号：2160352
[Abstract]:Objective to observe the value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic surgery in patients with choledocholithiasis and cholecystolithiasis. Effects of related inflammatory factors and serum levels of urinary trypsinogen-2. Methods 184 cases of choledocholithiasis with cholecystolithiasis treated in our hospital from June 2014 to May 2016 were selected and divided into two groups according to random digital table, 92 cases in each group. The observation group was treated with ERCP combined with laparoscopic surgery, the control group was treated with traditional open exploration surgery, the two groups were treated with 蠂 2 test, the operative effect and complications were compared by 蠂 2 test, and the operation time was compared by t test. The serum levels of interleukin (IL) -1 and IL-6 / C reactive protein (CRP) and urinary trypsinogen 2 (urinary trypsinogen 2) were compared between the two groups at different time points before and after operation by F / t test. Results there were 90 cases of primary stone removal in the observation group and 97.83 cases in the control group, 89 cases in the control group, with a clearance rate of 96.744.There was no significant difference between the two groups in the primary stone clearance rate (蠂 2 + 0.21 P 0.05), 92 cases in the observation group, 92 cases in the observation group, and 92 cases in the control group. The clearance rate was 100 and 92 cases in the control group. There was no significant difference between the two groups in the clearance rate of secondary stones (蠂 2 + 0.005), the operative time in the observation group was (122.36 卤18.75) minutes, the control group was (118.24 卤14.52) minutes, the difference between the two groups was not significant (P0.05), the intraoperative bleeding volume in the observation group was (25.35 卤5.64) ml, which was significantly lower than that in the control group (84.16 卤7.75) ml (/ t 58.85 P0.01). The anal exhaust time in the observation group was (1.19 卤0.46) days, significantly shorter than that in the control group (2.58 卤0.73) d (/ t 15.45, P 0.01), the hospitalization time in the observation group was (7.18 卤2.34) days, which was significantly shorter than that in the control group (14.67 卤4.13) d (/ t 15.13, P 0.01), the incidence of complications in the observation group was 2.17, which was significantly lower than that in the control group (10.87%, P 0.05), and the IL-1 level in the observation group was significantly lower than that in the control group at 3 hours and 1 day after operation (P < 0.05). 鍒负(23.78卤8.84)渭g/L,(36.78卤5.36)渭g/L,(6.64卤1.65)渭g/L,瀵圭収缁勫垎鍒负(55.63卤13.35)渭g/L,(121.35卤26.34)渭g/L,(18.24卤17.86)渭g/L,瑙傚療缁勫悇鏃剁偣琛，
本文编号：2160352
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