线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术对胆总管结石患者内镜逆行胰胆管造影术后胆囊功能的影响

Effect of linear echoendoscope guided precise endoscopic sphincterotomy on function of gallbladder in patients with calculus of common bile duct after endoscopic retrograde cholangiopancreatography

摘要:

目的 探讨线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术（EST）对胆总管结石患者内镜逆行胰胆管造影术（ERCP）的术后胆汁淀粉酶（BA）、胆汁细菌阳性率和隐匿性胰胆反流（OPBR）的影响。方法 选择2021年6月－2023年2月在该院进行ERCP的146例胆总管结石患者作为研究对象，患者需要行EST，根据EST的不同分为两组，各73例。观察组接受线阵超声内镜引导精准EST治疗，对照组行传统EST治疗。观察两组患者手术情况。比较术前、术后1和3 d两组患者肝功能指标［总胆红素（TBiL）、综合胆红素（CB）和丙氨酸转氨酶（ALT）等］、炎症和应激指标［C反应蛋白（CRP）、高迁移率族蛋白B1（HMGB1）、皮质醇（Cor）和去甲肾上腺素（NE）等］，以及BA和胆汁细菌阳性率。统计两组患者手术并发症和术后12个月复发情况。结果 两组患者取石成功率和手术时间比较，差异均无统计学意义（P > 0.05）。观察组术中出血量少于对照组，住院时间短于对照组，差异均有统计学意义（P < 0.05）。术后1和3 d，两组患者TBiL、CB和ALT低于术前，差异均有统计学意义（P < 0.05），组间比较，差异均无统计学意义（P > 0.05）。术后1和3 d，两组患者血清CRP、HMGB1、Cor和NE水平及BA浓度高于术前，观察组低于对照组，差异均有统计学意义（P < 0.05）。对照组术后1和3 d胆汁细菌阳性率高于术前，差异有统计学意义（P < 0.05），观察组手术前后各时点胆汁细菌阳性率比较，差异无统计学意义（P > 0.05），观察组术后1和3 d胆汁细菌阳性率低于对照组（P < 0.05）。观察组OPBR发生率和术后12个月复发率（15.07%和1.37%）低于对照组（57.53%和10.96%），差异均有统计学意义（P < 0.05）。结论 线阵超声内镜引导精准EST相对于传统EST，能有效减少十二指肠乳头括约肌损伤，避免肠胆反流，抑制BA分泌及细菌增殖，降低OPBR的发生风险。

Abstract:

Objective To investigate the effect of linear echoendoscope guided precise endoscopic sphincterotomy (EST) on positive rates of bile amylase (BA) and bile bacteria as well as occult pancreaticobiliary reflux (OPBR) in patients with calculus of common bile duct after endoscopic retrograde cholangiopancreatography (ERCP).Methods The subjects of this study, 146 patients with calculus of common bile duct who underwent EST for ERCP from June 2021 to February 2023, were divided into two groups based on EST type, each with 73 cases. Observation group was administrated with linear echoendoscope guided precise EST, control group was administrated traditional EST. The operation conditions of both groups were observed. Liver function indexes [total bilirubin (TBiL), conjugated bilirubin (CB) and alanine aminotransferase (ALT)], inflammatory and stress indicators [C-reactive protein (CRP), high mobility group box-1 protein (HMGB1), cortisol (Cor), norepinephrine (NE)], and the positive rates of BA and bile bacteria were compared between the two groups before operation and 1, 3 days after operation. The postoperative complications and recurrence rate 12 months after operation were recorded.Results There was no significant difference in the success rate of lithotomy and operation time between the two groups (P > 0.05). The intraoperative blood loss in the observation group was less than that in the control group, and the hospital stay was shorter than that in the control group, and the differences were statistically significant (P < 0.05). 1 and 3 days after surgery, TBiL, CB and ALT in two groups were lower than those before surgery, the differences were statistically significant (P < 0.05), but there was no statistically significant difference between groups (P > 0.05). 1 and 3 days after surgery, serum CRP, HMGB1, Cor and NE levels and BA concentration in two groups were higher than those before surgery, and observation group was lower than control group, with statistical significance (P < 0.05). The positive rate of biliary bacteria 1 and 3 days after surgery in the control group was higher than that before surgery, the difference was statistically significant (P < 0.05); the positive rate of biliary bacteria in the observation group was not significantly different at different time points before and after surgery (P > 0.05); the positive rate of biliary bacteria in the observation group was lower than that in the control group 1 and 3 days after surgery (P < 0.05). The incidence of OPBR and postoperative recurrence rate at 12 months in the observation group (15.07% and 1.37%) were lower than those in the control group (57.53% and 10.96%), and the differences were statistically significant (P < 0.05).Conclusion Linear echoendoscope guided precise EST is more effective in mitigating duodenal papillary sphincter injury, preventing duodenal-biliary reflux, inhibiting BA secretion and bacterial proliferation, and reducing the risk of OPBR than traditional EST.