PTCSL术与ERCP+EST/ESBD术治疗胆总管结石的疗效及对肝功能、并发症风险的影响

Effects of PTCSL and ERCP+EST/ESBD on choledocholithiasis and on liver function and complication risk

摘要:

目的 比较经皮经肝胆道镜取石术（PTCSL）与经内镜逆行胰胆管造影术（ERCP）+经内镜十二指肠乳头括约肌切开取石术（EST）/经内镜十二指肠乳头小切开后球囊扩张取石（ESBD）治疗胆总管结石（CBDS）患者的效果。方法 选取2020年1月至2022年12月河南科技大学第一附属医院82例CBDS患者，按随机数字表法分成A组（n=41）、B组（n=41）。A组接受PTCSL术治疗，B组接受ERCP+EST/ESBD术治疗。比较两组手术指标、结石清除率、并发症发生率、手术前后肝功能指标［总胆红素（TBIL）、谷丙转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）］、应激指标［肿瘤坏死因子-α（TNF-α）、一氧化氮（NO）、白介素-6（IL-6）］水平。结果 两组胆道引流管拔除时间比较，差异无统计学意义（P>0.05），与B组比较，A组住院耗时及胃肠功能恢复时间更短，手术耗时更长，术中失血量更多（P<0.05）；A组结石清除率（100.00%，41/41）较B组（80.49%，33/41）高，并发症发生率（4.88%，2/41）较B组（21.95%，9/41）低（P<0.05）；术后3 d、5 d两组血清TBIL、ALT、AST、ALP水平均较术前降低（P<0.05），但A组与B组比较，差异无统计学意义（P>0.05）；术后3 d、5 d A组血清TNF-α、NO、IL-6水平较B组低（P<0.05）。结论 ERCP+EST/ESBD术与PTCSL术与治疗CBDS患者均能有效改善肝功能，且各有优势，前者有助于缩短手术耗时，减少术中出血，后者有助于提升结石清除率，降低并发症发生风险，且对机体产生创伤应激反应小，可缩短患者康复进程。

Abstract:

Objective To compare the efficacy of percutaneous transhepatic choledochoscopic lithotomy (PTCSL) with endoscopic retrograde cholangiopancreatography (ERCP) + endoscopic duodenal papillary sphincterotomy (EST)/endoscopic duodenal papillary sphincterotomy plus balloon dilation (ESBD) in the treatment of common bile duct stones (CBDS).Methods Eighty-two patients with CBDS treated in First Affiliated Hospital of Henan University of Science and Technology from January 2020 to December 2022 were selected and divided into group A (n=41) and group B (n=41) according to random number table method. Group A received PTCSL and group B received ERCP+EST/ESBD. Surgical indexes, stone clearance rate, complication rate, liver function indexes before and after surgery [total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP)], stress indexes [tumor necrosis factor-α (TNF-α), nitric oxide (NO), interleukin-6 (IL)] were compared between the two groups.Results There was no significant difference in the extraction time of biliary drainage tube between the two groups (P>0.05). Compared with group B, the hospitalization time and gastrointestinal function recovery time of group A were shorter, the operation time was longer, and the intraoperative blood loss was greater (P<0.05). The stone clearance rate of group A [100.00% (41/41)] was higher than that of group B [(80.49% (33/41)], and the complication rate of group A [4.88% (2/41)] was lower than that of group B [(21.95% (9/41)] (P<0.05). The levels of serum TBIL, ALT, AST and ALP in the two groups were decreased on the 3rd and 5th day after surgery (P<0.05), but there was no significant difference between group A and group B (P>0.05). The serum levels of TNF-α, NO and IL-6 in group A were lower than those in group B on the 3rd and 5th day after surgery (P<0.05).Conclusion Both ERCP+EST/ESBD and PTCSL can effectively improve liver function in the treatment of patients with CBDS, and each has its own advantages. The former is helpful to shorten the operation time and reduce intraoperative bleeding, while the latter is helpful to increase the calculus clearance rate and reduce the risk of complications. In addition, the traumatic stress response to the body is small, which can shorten the rehabilitation process of patients.