乳头括约肌小切开联合球囊扩张取石对老年复杂胆总管结石患者的取石效果及生活质量的影响

Effects of SEST combined with balloon dilation lithotomy on stone removal and quality of life in elderly patients with complex choledocholithiasis

中文关键词: 老年  胆总管结石  乳头括约肌切开  球囊扩张取石  取石时间

英文关键词: elderly  choledocholithiasis  small endoscopic sphincterotomy  balloon dilatation lithotomy  lithotomy time

中文摘要:

      目的 探究乳头括约肌小切开(SEST)联合球囊扩张取石治疗老年复杂胆总管结石患者的效果及对取石时间、急性胰腺炎发生率的影响.方法 选取2020年6月—2022年12月在青岛市胶州中心医院进行手术治疗的复杂胆总管结石老年患者105例,将采用SEST联合球囊扩张取石治疗的54例患者设为观察组,接受SEST联合常规取石网篮取石治疗的患者51例设为对照组.对比2组手术指标手术时长、取石情况、恢复情况,术后3 d记录并比较2组穿孔、迟发性出血、急性胰腺炎、高淀粉酶血症、胆道感染等并发症发生情况;对比2组术后24 h内应激反应指标值[皮质醇、肾上腺素]、疾病复发风险评分;比较2组治疗前、治疗14 d后胃肠病生活质量指数(GIQLI)变化.结果 2组手术时长差异无统计学意义(P＞0.05),观察组取石时间短于对照组,一次取石成功率高于对照组,机械碎石率低于对照组(P＜0.05);2组全身麻醉患者占比差异无统计学意义(P＞0.05),观察组全麻患者术后下床时间、住院时间均短于对照组(P＜0.05),2组住院费用差异无统计学意义(P＞0.05);术后3 d,观察组并发症发生率低于对照组(P＜0.05);观察组术后皮质醇水平、肾上腺素水平、疾病复发评分均低于对照组(P＜0.05);治疗14 d后,2组GIQLI评分均高于同组治疗前(P＜0.05),且观察组GIQLI评分高于对照组(P＜0.05).结论 对于复杂胆总管结石老年患者,SEST联合球囊扩张取石的取石效率更高,术后可显著降低并发症发生率,有效改善患者生活质量,具有一定的应用价值.

英文摘要:

      Objective To explore the effects of small endoscopic sphincterotomy(SEST)combined with balloon dila-tation lithotomy on complex choledocholithiasis in elderly patients and its influence on lithotomy time and incidence of acute pancreatitis.Methods 105 elderly patients with complex choledocholithiasis undergoing surgical treatment in Jiaozhou Central Hospital from June 2020 to December 2022 were selected.Among them,54 ones receiving SEST combined with balloon dilata-tion lithotomy were assigned to observation group,and 51 ones receiving SEST combined with conventional stone basket lithot-omy were assigned to control group.The surgical time,lithotomy conditions and recovery conditions were compared between the two groups.The incidence of complications such as perforation,delayed bleeding,acute pancreatitis,hyperamylasemia,biliary tract infection within 3 days after surgery were recorded and compared between the two groups.The stress response(cortisol,epinephrine)and risk score of disease recurrence within 24 hours after surgery were compared between the two groups.The changes in score of Gastrointestinal Quality of Life Index(GIQLI)were compared between the two groups before treatment and after 14 days of treatment.Results There was no statistical significance in surgical time between groups(P＞0.05).Compared with the control group,the lithotomy time in the observation group was shorter,the success rate of one-time lithotomy was higher,and the mechanical lithotripsy rate was lower(P＜0.05).There was no statistical difference in the pro-portion of patients with general anesthesia between the two groups(P＞0.05),but the postoperative ambulation time of general anesthesia patients and hospital stay in the observation group were shorter than those in the control group(P＜0.05).There was no significant difference in hospitalization cost between the two groups(P＞0.05).Within 3 days after surgery,the inci-dence of complications in the observation group was lower than that in the control group(P＜0.05).The levels of cortisol and epinephrine and score of disease recurrence after surgery of the observation group were lower than those of the control group(P＜0.05).After 14 days of treatment,the GIQLI scores of both groups were higher than those of the same group before treatment,and the scores of the observation group were higher than those of the control group(P＜0.05).Conclusion For elderly patients with complex choledocholithiasis,SEST combined with balloon dilatation lithotomy has high lithotomy efficien-cy.It can significantly reduce the incidence of complications after surgery and effectively improve the quality of life of patients,and has clinical application value.