摘要
目的分析内镜逆行胰胆管造影术(ERCP)联合乳头括约肌切开术治疗胆囊结石合并胆总管结石的临床效果及术后血清γ-谷氨酰转移酶(GGT)、瘦素、血尿酸水平与结石复发的相关性。方法前瞻性选取蚌埠医科大学第二附属医院普外科2020年5月至2023年5月收治的165例胆囊结石合并胆总管结石患者作为研究对象,所有患者均行ERCP联合乳头括约肌切开术治疗。分别于术前及术后3 d测定血清GGT、瘦素、血尿酸水平,术后3 d观察结石清除情况;术后随访1年,统计结石复发情况,并采用Spearman相关分析探讨血清GGT、瘦素、血尿酸水平与结石复发的相关性。结果165例患者采用ERCP联合乳头括约肌切开术治疗后,取石成功163例(98.79%),取石未成功2例(1.21%)。术后3 d血清GGT、瘦素、血尿酸水平明显低于术前,差异有统计学意义(P<0.05)。术后随访1年,163例取石成功患者中复发10例(6.13%),未复发153例(93.87%)。与未复发患者相比,复发患者术后并发症发生率、高血脂比例及术后3 d血清GGT、瘦素、血尿酸水平较高,差异有统计学意义(P<0.05)。Spearman相关分析显示,术后血清GGT、瘦素、血尿酸水平均与结石复发呈正相关(P<0.05)。结论胆囊结石合并胆总管结石患者采用ERCP联合乳头括约肌切开术治疗的临床效果较为理想,而术后血清GGT、瘦素、血尿酸水平与结石复发呈正相关。
Objective To analyze the clinical outcome of endoscopic retrograde cholangiopancreatography(ERCP)combined with papillary sphincterotomy in the treatment of gallbladder stones combined with choledocholithiasis and the correlation between postoperative serum gamma-glutamyltransferase(GGT),leptin,and serum uric acid levels and stone recurrence.Method Prospectively selected 165 patients with gallbladder stones combined with common bile duct stones admitted to the Department of General Surgery of the Second Affiliated Hospital of Bengbu Medical University from May 2020 to May 2023 as the study subjects,all of whom underwent ERCP combined with nipple sphincterotomy for the treatment of gallbladder stones therapy.The serum GGT,leptin,and serum uric acid levels were measured before and 3 d after the operation respectively,and the stone clearance was observed 3 d after the operation;the patients were followed up for 1 year after the operation,and the stone recurrence was counted,and Spearman’s correlation analysis was used to explore the correlation between the serum GGT,leptin,and serum uric acid levels and the stone recurrence.Result After 165 patients were treated with ERCP combined with nipple sphincterotomy,163 cases(98.79%)were successful in stone extraction and 2 cases(1.21%)were unsuccessful in stone extraction.Serum GGT,leptin,and serum uric acid levels were significantly lower than preoperative levels at 3 d postoperatively,and the difference was statistically significant(P<0.05).At 1-year postoperative follow-up,there were 10 cases of recurrence(6.13%)and 153 cases of non-recurrence(93.87%)among 163 patients with successful stone extraction.Compared with patients without recurrence,the incidence of postoperative complications,the proportion of hyperlipidemia,and the levels of serum GGT,leptin,and serum uric acid were higher in patients with recurrence in the 3d postoperative period,and the differences were statistically significant(P<0.05).Spearman’s correlation analysis showed that the levels of serum GGT,leptin,and serum uric acid were positively correlated with stone recurrence in the postoperative period(P<0.05).Conclusion Patients with gallbladder stones combined with common bile duct stones were treated with ERCP combined with nipple sphincterotomy with more favorable clinical results,while postoperative serum GGT,leptin,and serum uric acid levels were positively correlated with stone recurrence.
作者
李乃树
曹登义
陈正民
姚超
马强
孙发缔
许兆龙
Li Naishu;Cao Dengyi;Chen Zhengmin;Yao Chao;Ma Qiang;Sun Fadi;Xu Zhaoong(Department of General Surgery,Second Affiliated Hospital of Bengbu Medical University,Bengbu Anhui 233000,China)
出处
《中国医刊》
2025年第3期283-286,共4页
Chinese Journal of Medicine
基金
2024年度医院住培教学研究专项课题立项项目(BYZP202402)
安徽省高等学校科学研究项目(2023AH051940)
蚌埠医学院自然科学类项目(2021byzd195)。
关键词
胆囊结石合并胆总管结石
Γ-谷氨酰转移酶
瘦素
血尿酸
内镜逆行胰胆管造影术
乳头括约肌切开术
Gallbladder stones combined with choledocholithiasis
Gamma glutamyltransferase
Leptin
Serum uric acid
Endoscopic retrograde cholangiopancreatography
Papillary sphincterotomy
