摘要
目的:探讨经胆囊管汇入部切开胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效及对患者血清淀粉酶(AMS)、皮质醇(Cor)水平的影响。方法:选取2017年2月至2018年4月邢台医学高等专科学校第二附属医院收治的胆囊结石合并胆总管结石患者160例,使用随机数字表法分为观察组和对照组,每组80例。对照组患者采用LTCBDE术治疗,观察组患者在LTCBDE术后联合间苯三酚治疗。观察两组患者的围术期指标水平,治疗前后血清AMS、Cor、肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)]及炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)]水平,比较两组患者并发症发生情况和生活质量评分(quality of life score,QOL)的差异。结果:两组患者手术时间和术中出血量的差异均无统计学意义(P>0.05);观察组患者术后排气时间、术后住院时间明显短于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者血清AMS水平较治疗前明显升高,Cor水平较治疗前明显降低,且观察组患者AMS、Cor水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TBIL、ALT及AST水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TNF-α、IL-6及IL-8水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。两组患者胆管狭窄、切口感染、残留结石及胆瘘的发生率的差异均无统计学意义(P>0.05)。治疗后,两组患者QOL评分较治疗前明显升高,且观察组患者明显高于对照组,差异均有统计学意义(P<0.05)。结论:LTCBDE术后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效显著,可明显改善患者血清AMS、Cor水平,降低炎症因子水平,安全性较好。
OBJECTIVE:To probe into the efficacy of phloroglucinol in treatment of gallstone complicated with choledocholithiasis after laparoscopic transcystic common bile duct exploration(LTCBDE)and its effect on serum amylase(AMS)and cortisol(Cor)levels.METHODS:160 patients with gallstone complicated with choledocholithiasis admitted into the Second Affiliated Hospital of Xingtai Medical College from Feb.2017 to Apr.2018 were selected and randomly divided into observation group and control group,with 80 cases in each group.The control group was given LTCBDE,while the observation group was given phloroglucino after LTCBDE.The perioperative indices,serum AMS,Cor,liver function indices[alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)]and inflammatory factor[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)]of the two groups were observed before and after treatment.Differences in incidences of complications and scores of quality of life(QOL)between two groups were compared.RESULTS:There were no statistical significance in differences in operation duration and intraoperative bleeding volume between two groups(P>0.05);the postoperative evacuation time and hospital stay of observation group were significantly shorter than those of the control group,with statistically significant differences(P<0.05).After treatment,the serum AMS levels of both groups were significantly increased,the Cor levels were significantly decreased,the serum AMS and Cor levels of observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).After treatment,the TBIL,ALT and AST levels of both groups were significantly decreased,and those of the observation group were significantly lower than the control group,with statistically significant differences(P<0.05).After treatment,the TNF-α,IL-6 and IL-8 levels of both groups were significantly decreased,and those of the observation group were significantly lower than the control group,with statistically significant differences(P<0.05).There were no statistical significance in differences in incidences of biliary stricture,incision infection,residual stone and biliary fistula between two groups(P>0.05).After treatment,the QOL scores of both groups were significantly increased,and that of the observation group was significantly higher than the control group,with statistically significant differences(P<0.05).CONCLUSIONS:The efficacy of phloroglucinol in treatment of gallstone complicated with choledocholithiasis after LTCBDE is remarkable,which can effectively improve patients’serum AMS and Cor levels,reduce inflammatory factor level,with good safety.
作者
王强
孙伟
董韶华
WANG Qiang;SUN Wei;DONG Shaohua(Dept.of Hepatobiliary Surgery,the Second Affiliated Hospital of Xingtai Medical College,Hebei Xingtai 054000,China)
出处
《中国医院用药评价与分析》
2020年第2期190-193,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
邢台市科技计划项目(No.2018ZC203).
作者简介
王强,主治医师。研究方向:肝胆外科。E-mail:420510356@qq.com;通信作者:董韶华,主治医师。研究方向:肝胆外科。E-mail:775019718@qq.com
