[1]王卫伟,王忠玉.腹腔镜联合胆道镜治疗急性胆源性胰腺炎伴胆囊结石疗效及对患者血清巨噬细胞炎性蛋白-1α、巨噬细胞炎性蛋白-1β和单核细胞趋化因子蛋白-1水平的影响[J].陕西医学杂志,2021,50(9):1114-1118.[doi:DOI:10.3969/j.issn.1000-7377.2021.09.018]
　WANG Weiwei,WANG Zhongyu.Efficacy of laparoscopy combined with choledochoscopy in treatment of acute biliary pancreatitis complicated with gallbladder stones and its effect on serum MIP-1α,MIP-1β and MCP-1 levels[J].,2021,50(9):1114-1118.[doi:DOI:10.3969/j.issn.1000-7377.2021.09.018]
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腹腔镜联合胆道镜治疗急性胆源性胰腺炎伴胆囊结石疗效及对患者血清巨噬细胞炎性蛋白-1α、巨噬细胞炎性蛋白-1β和单核细胞趋化因子蛋白-1水平的影响
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年9期
页码:
1114-1118
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
Efficacy of laparoscopy combined with choledochoscopy in treatment of acute biliary pancreatitis complicated with gallbladder stones and its effect on serum MIP-1α,MIP-1β and MCP-1 levels
作者:
王卫伟1; 王忠玉2
(1.陕西省核工业二一五医院,陕西 咸阳 712000; 2.渭北中心医院,陕西 渭南 715100)
Author(s):
WANG Weiwei; WANG Zhongyu
(No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China)
关键词:
急性胆源性胰腺炎伴胆囊结石;  腹腔镜;  胆道镜;  巨噬细胞炎性蛋白-1α;  巨噬细胞炎性蛋白-1β;  单核细胞趋化因子蛋白-1
Keywords:
Acute biliary pancreatitis complicated with gallbladder stones;  Laparoscopy;  Choledochoscopy;  MIP-1α;  MIP-1β;  MCP-1
分类号:
R 657.4
DOI:
DOI:10.3969/j.issn.1000-7377.2021.09.018
文献标志码:
A
摘要:
目的:观察腹腔镜联合胆道镜治疗急性胆源性胰腺炎伴胆囊结石疗效及对患者血清巨噬细胞炎性蛋白-1α(MIP-1α)、巨噬细胞炎性蛋白-1β(MIP-1β)及单核细胞趋化因子蛋白-1(MCP-1)水平的影响。方法:选取急性胆源性胰腺炎伴胆囊结石患者90例,根据治疗方法不同分为传统组(38例)和双镜组(52例)。传统组给予开腹胆囊切除联合胆总管取石治疗。双镜组给予腹腔镜胆囊切除联合胆道镜取石治疗。比较两组围手术期指标(术中失血量、手术时间、肛门排气时间、腹部症状缓解时间、住院时间)。比较两组手术前后视觉模拟量表(VAS)评分,血清炎性细胞因子(MIP-1α、MIP-1β、MCP-1)和肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)]水平。比较两组术后并发症发生情况。结果:双镜组患者术中失血量、肛门排气时间、腹部症状缓解时间、住院时间明显低于传统组(均P<0.05)。两组手术时间比较无统计学差异(P>0.05)。双镜组术后1 d VAS评分明显低于传统组(P<0.05)。术后7 d,两组血清MIP-1α、MIP-1β、MCP-1、ALT、AST、TBIL水平较术前显著下降,且双镜组明显低于传统组(均P<0.05)。双镜组患者切口感染发生率明显低于传统组(P<0.05)。两组胆漏、胆道感染、胰腺炎、胆总管结石残留发生率比较无统计学差异(均P>0.05)。结论:腹腔镜联合胆道镜治疗急性胆源性胰腺炎伴胆囊结石疗效理想,较传统开腹手术具有失血量少、术后恢复快等优势,有利于患者术后短期内疼痛缓解,降低MIP-1α、MIP-1β、MCP-1水平。
Abstract:
Objective:To observe the efficacy of laparoscopy combined with choledochoscopy in the treatment of acute biliary pancreatitis complicated with gallbladder stones and its effect on levels of serum MIP-1α,MIP-1β and MCP-1.Methods:90 cases of acute biliary pancreatitis complicated with gallstone were selected and divided into traditional group(38 cases)and laparoscopy-choledochoscopy group(52 cases)according to different treatment methods.The traditional group was treated with open cholecystectomy combined with choledocholithotomy.The laparoscopy-choledochoscopy group was treated with laparoscopic cholecystectomy combined with choledochoscopy.The perioperative indexes(intraoperative blood loss,operation time,anal exhaust time,abdominal symptom relief time,hospitalization time)were compared between the two groups.VAS score and serum inflammatory cytokines(MIP-1α,MIP-1β,MCP-1)and liver function indexes(ALT,AST,TBIL)before and after operation were compared between the two groups.The postoperative complications of the two groups were compared.Results:The intraoperative blood loss,anal exhaust time,abdominal symptom relief time and hospitalization time in the laparoscopy-choledochoscopy group were significantly lower than those in the traditional group(all P<0.05).There was no significant difference in operation time between the two groups(P>0.05).One day after operation,VAS score of laparoscopy-choledochoscopy group was significantly lower than that of traditional group(P<0.05).At the 7th day after operation,the serum levels of MIP-1,MIP-1β,MCP-1,ALT,AST and TBIL in the two groups were lower than those before operation,and the laparoscopy-choledochoscopy group was lower than the traditional group(all P<0.05).The incidence of incision infection in the laparoscopy-choledochoscopy group was lower than that in the traditional group(P<0.05).There was no significant difference in the incidence of bile leakage,biliary tract infection,pancreatitis and residual common bile duct stones between the two groups(all P>0.05).Conclusion:Laparoscopy combined with choledochoscopy has an ideal efficacy in the treatment of acute biliary pancreatitis complicated with gallbladder stones.It has the advantages of less blood loss and faster postoperative recovery than traditional laparotomy,and it is more conducive to short-term postoperative pain relief and decrease of MIP-1α,MIP-1β and MCP-1.

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备注/Memo

备注/Memo:
基金项目:陕西省重点研发计划项目(2017ZDXM-SF-023)
更新日期/Last Update: 2021-09-06