【摘要】 目的 观察难治性胆总管结石(CBDS)患者采用钬激光碎石、经内镜逆行胰胆管造影术联合治疗的临床效果。方法 选取2019年6月至2021年5月石家庄市第三医院收治的85例难治性CBDS患者，依据手术方法的不同分为研究组(钬激光碎石+经内镜逆行胰胆管造影术治疗)44例和对照组(胆总管切开取石外科手术治疗)41例。对比两组患者手术相关指标、取石成功率、炎性因子水平及并发症发生情况。结果 研究组手术时间[(35.28±10.15)min比(102.57±34.56)min]、术后卧床时间[(1.58±0.37)d比(3.86±0.73)d]及住院时间[(6.41±0.52)d比(11.85±2.76)d]均短于对照组(t=12.361、18.347、12.837,均P<0.01)。研究组取石成功率与对照组相近(97.73%比95.12%)(χ~2=0.423、P=0.515)。研究组术后IL-1β[(6.48±0.81)比(25.46±4.83)ng/mL]、IL-6[(4.73±1.15)比(13.75±2.86)ng/mL]及TNF-α[(2.56±0.46)比(6.85±0.76)μg/mL]水平均低于对照组(t=25.639、19.318、31.729,均P<0.01)。研究组并发症总发生率为低于对照组(4.55%比21.95%)(χ~2=5.707、P=0.017)。结论 钬激光碎石、经内镜逆行胰胆管造影术联合治疗难治性CBDS患者效果较好。更多还原

【Abstract】 Objective To observe the clinical effect of combined holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography in patients with refractory common bile duct stones(CBDS). Methods A total of 85 patients with refractory CBDS who were admitted to the Third Hospital of Shijiazhuang City(June 2019 to May 2021) were selected and divided into study groups(holmium laser lithotripsy + endoscopic retrograde cholangiopancreatography) according to different surgical methods. treatment, 44 cases) and control group(surgical treatment of choledocholithotomy, 41 cases). The operation-related indicators, stone removal success rate, inflammatory factor levels and complications were compared between the two groups. Results The operation time of the study group [(35.28±10.15) vs(102.57±34.56) min], postoperative bed time [(1.58±0.37) vs(3.86±0.73) d] and hospital stay [(6.41±0.52) vs(11.85) ±2.76)d] were shorter(t=12.361, 18.347, 12.837, all P<0.001). The success rate of stone removal in the study group(97.73% vs 95.12%) was similar(χ~2=0.423, P=0.515). The postoperative IL-1β[(6.48±0.81)vs(25.46±4.83)ng/mL], IL-6[(4.73±1.15)vs(13.75±2.86)ng/mL] and TNF-α[(2.56) ±0.46) vs(6.85±0.76) μg/mL] levels were lower(t=25.639, 19.318, 31.729, all P<0.001). The total incidence of complications in the study group(4.55% vs 21.95%) was lower(χ~2=5.707, P=0.017). Conclusion The combination of holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography is effective in the treatment of refractory CBDS patients.更多还原