SpyGlass DS直视胆道镜系统辅助内镜逆行胰胆管造影术治疗复杂胆管结石的临床价值分析

Clinical value analysis of the SpyGlass DS direct-view choledochoscope system assisted endoscopic retrograde cholangiopancreatography in the treatment of complex bile duct stones

摘要:

目的 探讨SpyGlass DS直视胆道镜系统辅助内镜逆行胰胆管造影术（ERCP）治疗复杂胆管结石的临床疗效。方法 该研究为回顾性对照设计，收集2022年1月－2025年5月河南中医药大学第一附属医院及郑州大学第一附属医院收治的92例复杂胆管结石患者的临床资料，根据治疗方案分为观察组和对照组，各46例。观察组予以SpyGlass DS直视胆道镜系统辅助ERCP治疗，对照组予以单纯ERCP治疗。观察两组患者清石效果、围手术期指标和并发症发生情况，比较手术前后应激反应指标［皮质醇（Cor）、去甲肾上腺素（NE）和促肾上腺皮质激素（ACTH）］、总胆红素（TBiL）、总胆汁酸（TBA）和胃肠道生活质量指数（GIQLI）评分。结果 观察组一次结石清除率和住院费用高于对照组，手术时间长于对照组，住院时间短于对照组，并发症发生率低于对照组，差异均有统计学意义（P < 0.05）；观察组术后1和3 d血清Cor、NE和ACTH水平低于对照组，术后3和7 d的TBiL和TBA水平低于对照组，差异均有统计学意义（P < 0.05）；两组患者术后1个月GIQLI评分高于术前，且观察组高于对照组，差异有统计学意义（P < 0.05）。结论 SpyGlass DS直视胆道镜系统辅助ERCP，能提高复杂胆管结石的清石效果，减轻应激反应，减少并发症，改善胆功能，提高患者生活质量，但会增加手术难度和患者经济负担。临床可根据患者情况选择合适的手术方法。

Abstract:

Objective To investigate the clinical efficacy of the SpyGlass DS direct-view choledochoscopy system assisted endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of complex bile duct stones.Methods A retrospective control design was used in this study. The clinical data of 92 patients with complex bile duct stones who were treated from January 2022 to May 2025 were collected. They were grouped according to the treatment plan, with 46 cases in each group. The observation group was treated with the SpyGlass DS direct-view choledochoscopy system-assisted ERCP, and the control group was treated with ERCP alone. The stone clearance effect, perioperative conditions and complications of the two groups were observed. The stress response indexes [cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)], total bilirubin (TBiL), total bile acid (TBA) and gastrointestinal quality of life index (GIQLI) score were compared.Results The one-time stone clearance rate and hospitalization cost of the observation group were higher than those of the control group, the operation time was longer than that of the control group, the hospitalization time was shorter than that of the control group, and the incidence of complications was lower than that of the control group, the differences were statistically significant (P < 0.05). The levels of serum Cor, NE and ACTH at 1 and 3 d after operation, and the levels of TBiL and TBA at 3 and 7 d after operation in the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The GIQLI scores of the two groups of patients one month after the operation were higher than those before the operation, and the score of the observation group was higher than that of the control group, the differences were statistically significant (P < 0.05).Conclusion The SpyGlass DS direct-view choledochoscopy system assisted ERCP can improve the stone clearance effect of complex bile duct stones, reduce stress responses, decrease complications, improve bile function, and enhance the quality of life of patients. However, it will increase the difficulty of the surgery and the economic burden on the patient. Clinically, appropriate surgical methods can be selected based on the patient's condition.