【摘要】：目的觀察經(jīng)內(nèi)鏡逆行胰膽管造影(ERCP)聯(lián)合腹腔鏡手術(shù)在膽總管結(jié)石伴膽囊結(jié)石患者中的應(yīng)用價(jià)值以及該手術(shù)方式對(duì)患者臨床療效、相關(guān)炎癥因子及血清尿胰蛋白酶原-2水平的影響。方法選取我院2014年6月至2016年5月收治的184例膽總管結(jié)石伴膽囊結(jié)石患者作為研究對(duì)象,按照隨機(jī)數(shù)字表法將其分成兩組,每組92例。其中觀察組給予ERCP聯(lián)合腹腔鏡手術(shù)治療,對(duì)照組給予傳統(tǒng)開腹探查手術(shù)治療,采用χ2檢驗(yàn)比較兩組患者的手術(shù)療效及并發(fā)癥情況;采用t檢驗(yàn)比較兩組手術(shù)時(shí)間、術(shù)中出血量等手術(shù)相關(guān)指標(biāo);采用F檢驗(yàn)/t檢驗(yàn)比較兩組手術(shù)前后不同時(shí)點(diǎn)血清白細(xì)胞介素(IL)-1、IL-6、C反應(yīng)蛋白(CRP)水平以及血清尿胰蛋白酶原-2水平。結(jié)果觀察組一期結(jié)石清除90例,清除率97.83%,對(duì)照組一期結(jié)石清除89例,清除率96.74%,兩組一期結(jié)石清除率比較差異無統(tǒng)計(jì)學(xué)意義(χ2=0.21,P0.05);觀察組二期結(jié)石清除92例,清除率100%,對(duì)照組二期結(jié)石清除92例,清除率100%,兩組二期結(jié)石清除率比較差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.00,P0.05);觀察組手術(shù)時(shí)間為(122.36±18.75)min,對(duì)照組為(118.24±14.52)min,兩組比較差異無統(tǒng)計(jì)學(xué)意義(t=1.67,P0.05);觀察組術(shù)中出血量(25.35±5.64)ml,明顯少于對(duì)照組(84.16±7.75)ml(t=58.85,P0.01);觀察組肛門排氣時(shí)間(1.19±0.46)d,明顯短于對(duì)照組(2.58±0.73)d(t=15.45,P0.01);觀察組住院時(shí)間(7.18±2.34)d,明顯短于對(duì)照組(14.67±4.13)d(t=15.13,P0.01);觀察組并發(fā)癥發(fā)生率為2.17%,相對(duì)于對(duì)照組的10.87%明顯下降(χ~2=5.71,P0.05);觀察組術(shù)后3 h、1 d、3 d時(shí)IL-1水平分別為(23.78±8.84)μg/L、(36.78±5.36)μg/L、(6.64±1.65)μg/L,對(duì)照組分別為(55.63±13.35)μg/L、(121.35±26.34)μg/L、(18.24±17.86)μg/L,觀察組各時(shí)點(diǎn)血清IL-1水平均明顯低于對(duì)照組(t=19.08、30.18、6.20,P0.01);觀察組術(shù)后3 h、1 d、3 d時(shí)IL-6水平分別為(17.53±6.34)μg/L、(31.24±5.87)μg/L、(2.56±1.24)μg/L,對(duì)照組分別為(48.46±12.78)μg/L、(112.56±24.63)μg/L、(17.24±12.45)μg/L,觀察組各時(shí)點(diǎn)血清IL-6水平均明顯低于對(duì)照組(t值分別為20.80、30.81、11.25,P0.01);觀察組術(shù)后3 h、1 d、3 d時(shí)CRP水平分別為(236.78±43.56)μg/L、(445.67±53.67)μg/L、(59.42±28.34)μg/L,對(duì)照組分別為(392.66±65.35)μg/L、(995.25±86.25)μg/L、(158.37±75.24)μg/L,觀察組各時(shí)點(diǎn)血清CRP水平均明顯低于對(duì)照組(t=19.04、51.89、11.80,P0.01);觀察組組術(shù)后3 h、1 d、3 d時(shí)血清尿胰蛋白酶原-2水平分別為(37.12±5.12)ng/ml、(35.99±4.97)ng/ml、(35.84±4.13)ng/ml,對(duì)照組分別為(36.67±5.34)ng/ml、(36.12±4.75)ng/ml、(36.03±4.61)ng/ml,兩組各時(shí)點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(t值分別為0.58、0.18、0.29,P0.05)。結(jié)論 ERCP聯(lián)合腹腔鏡手術(shù)作為一種微創(chuàng)手術(shù)方案對(duì)膽總管結(jié)石伴膽囊結(jié)石患者具有較好的臨床療效,且術(shù)后炎癥反應(yīng)輕,不良并發(fā)癥少,值得臨床推廣。
[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 鹵18.75) minutes, the control group was (118.24 鹵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 鹵5.64) ml, which was significantly lower than that in the control group (84.16 鹵7.75) ml (/ t 58.85 P0.01). The anal exhaust time in the observation group was (1.19 鹵0.46) days, significantly shorter than that in the control group (2.58 鹵0.73) d (/ t 15.45, P 0.01), the hospitalization time in the observation group was (7.18 鹵2.34) days, which was significantly shorter than that in the control group (14.67 鹵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負(fù)(23.78鹵8.84)渭g/L,(36.78鹵5.36)渭g/L,(6.64鹵1.65)渭g/L,瀵圭収緇勫垎鍒負(fù)(55.63鹵13.35)渭g/L,(121.35鹵26.34)渭g/L,(18.24鹵17.86)渭g/L,瑙傚療緇勫悇鏃剁偣琛，

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