不同手术时机下行ERCP治疗对老年急性胆源性胰腺炎患者术后康复效果的影响

Effects of ERCP treatment at different surgical timing on postoperative rehabilitation in elderly patients with acute biliary pan-creatitis

中文关键词: 老年  急性胆源性胰腺炎  经内镜逆行性胰胆管造影术  腹腔镜下胆囊切除术  康复效果

英文关键词: elderly  acute biliary pancreatitis  endoscopic retrograde cholangiopancreatography  laparoscopic cholecys-tectomy  rehabilitation effect

中文摘要:

      目的 探究在不同手术时机下行经内镜逆行性胰胆管造影术(ERCP)治疗对老年急性胆源性胰腺炎患者术后康复效果的影响.方法 参照实施ERCP的手术时间不同将2020年6月—2024年6月于鄂尔多斯市中心医院入院就诊的245例老年急性胆源性胰腺炎患者划分为早期ERCP组(入院后72 h内行ERCP,n=143)与延期ERCP组(入院72 h后行ERCP,n=102).2组均接受ERCP+LC手术治疗.比较2组手术相关指标值、术后临床相关指标值、肝功能指标值[总胆红素(Total bilirubin,TBIL)、谷丙转氨酶(Alanine aminotransferase,ALT)、天门冬氨酸转氨酶(Aspartate amin-otransferase,AST)]、血清炎症因子[超敏 C 反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、白细胞介素 6(Interleu-kin-6,IL-6)、白细胞计数(White blood cell,WBC)]水平、术后并发症发生情况及疾病复发情况.结果 与延期ERCP组比较,早期ERCP组的ERCP操作时间较长(P＜0.05),饮食恢复时间及总胆红素恢复时间均缩短(P＜0.05).与延期ERCP组比较,早期ERCP组术后24 h血清hs-CRP、IL-6、WBC和TBIL水平均较高(P＜0.05),ALT与AST水平差异无统计学意义(P＞0.05),但其术后7 d的血清炎症因子水平差异无统计学意义(P＞0.05).2组术后并发症的发生率及疾病复发情况差异无统计学意义(P＞0.05).结论 在身体状况允许的情况下,与延期手术相比,老年急性胆源性胰腺炎患者于发病早期及时行ERCP手术治疗,可能不影响其术后各项指标的恢复,且不会增加并发症的发生.

英文摘要:

      Objective To explore the effects of endoscopic retrograde cholangiopancreatography(ERCP)treatment at different surgical timing on postoperative rehabilitation in elderly patients with acute biliary pancreatitis.Methods Based on different ERCP implementation timings,245 elderly patients with acute biliary pancreatitis admitted to Central Hospital of Ordos City from June 2020 to June 2024 were divided into early ERCP group(ERCP performed within 72 h of admission,n=143)and delayed ERCP group(ERCP performed after 72 h of admission,n=102).Both groups underwent ERCP+laparoscopic cholecystectomy(LC).The surgery-related indexes,postoperative clinical indexes,liver function indexes[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)],serum inflammatory factors[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),white blood cell count(WBC)],postoperative complications,and dis-ease recurrence were compared between the two groups.Results Compared with the delayed ERCP group,the early ERCP group showed longer ERCP procedure time(P＜0.05),shorter dietary recovery time and TBIL normalization time(P＜0.05).At 24 h after surgery,the levels of serum hs-CRP,IL-6,WBC and TBIL in the early ERCP group were higher than those in the delayed ERCP group(P＜0.05),but there was no significant difference in the levels of ALT and AST between the two groups(P＞0.05).At7d after surgery,there was no significant difference in the levels of serum inflammatory factors be-tween the two groups(P＞0.05).There was no significant difference in the incidence of postoperative complications and dis-ease recurrence between the two groups(P＞0.05).Conclusion If the physical condition allows,compared with delayed sur-gery,timely ERCP treatment in the early stage of acute biliary pancreatitis in elderly patients may not affect the rehabilitation of various postoperative indexes and will not increase the incidence of complications.