内镜逆行胰胆管造影术中局部抗生素灌洗降低胆道结石复发率的研究

Intraoperative topical antibiotic lavage during ERCP reduced the recurrence of biliary stones

摘要:

 目的   探讨内镜逆行胰胆管造影术（ERCP）术中局部抗生素灌洗降低胆道结石复发率的效果。方法  胆道结石患者180例根据随机抽签法分为治疗组与对照组各90例，两组都给予ERCP手术治疗，同时治疗组在术中给予局部抗生素灌洗治疗，观察两组的近期效果，同时随访调查胆道结石复发情况。结果   治疗组的一次与二次取净结石比例分别为91.1%和100.0%，对照组分别为90.0%和100.0%，组间对比差异无统计学意义（P >0.05）。术后14天治疗组与对照组的治疗有效率分别为96.7%和87.8%，治疗组的治疗有效率明显高于对照组（P <0.05）。治疗组术后14天内急性胰腺炎、胆管炎、消化道出血和消化道穿孔等并发症发生情况明显少于对照组（P <0.05）。手术之后两组直接胆红素（DB）和总胆红素（TBIL）、血清谷丙转氨酶（ALT）和谷草转氨酶（AST）的含量都大幅度减少（P<0.05），并且对照组上述4种物质的含量要高于治疗组（P <0.05）。所有患者术后随访调查6个月，治疗组的复发率为2.2%（2/90），对照组为11.1%（10/90），治疗组术后复发率明显低于对照组（P <0.05）。结论   ERCP术治疗胆道结石具有很高的成功率，局部抗生素灌洗的应用能促进恢复肝胆的生理学功能，减少并发症的发生，提高总体治疗疗效，也有利于降低胆道结石的复发，有很好的应用价值。

Abstract:

Objective To investigate the effects of intraoperative topical antibiotic lavage during endoscopic retrograde cholangiopancreatography (ERCP). Methods 180 patients with biliary calculi were randomly divided into treatment group and control group, all the patients received endoscopic retrograde cholangiopancreatography surgery, while the treatment group were given intraoperative topical antibiotic lavage, then observe the short-term effects and the recurrence rates of biliary calculi. Results The primary and secondary take calculi rates were 91.1 % and 100.0 % in treatment group, the control group were 90.0 % and 100.0 %, comparison between the two groups shows no significant difference (P > 0.05). Efficacy rate of postoperative 14 d of the treatment group and control group were 96.7 % and 87.8 % (P < 0.05). acute pancreatitis, cholangitis, gastrointestinal bleeding, gastrointestinal perforation and other complications of postoperative 14 d in the treatment group were significantly less than the control group (P < 0.05). Serum alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin values of postoperative 14 d were significantly decreased in the two groups (P < 0.05), while the serum alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin values of postoperative 14 d in treatment group were significantly lower than the control group (P < 0.05). All patients were followed up six months, the recurrence rate in the treatment group was 2.2 % (2/90), while 11.1 % (10/90) in control group. The treatment group recurrence rate was significantly lower than control group (P < 0.05). Conclusions ERCP treatment for biliary calculi has high success rate, the application of topical antibiotic lavage can contribute to the restoration of physiological functions of the liver and gallbladder, reduce complications and improve overall treatment efficacy, but also it is help to reduce the recurrence of biliary stones that has better values.