内镜逆行胰胆管造影联合SpyGlass系统治疗胆总管结石继发急性胆囊炎的效果观察

陶丽莹; 王宏光; 郭享; 周舰; 郭庆梅; 王曼彤

doi:10.3969/j.issn.1001-5256.2022.08.025

内镜逆行胰胆管造影联合SpyGlass系统治疗胆总管结石继发急性胆囊炎的效果观察

DOI: 10.3969/j.issn.1001-5256.2022.08.025

吉林市人民医院消化内科，吉林吉林 132001

基金项目:

吉林市医疗卫生指导性计划项目 (20210409008);

吉林省卫生健康科技能力提升项目 (2021LC120)

伦理学声明：本研究于2021年12月23日经由吉林市人民医院伦理委员会批准，批号：EC-20190719-1026。所有患者均签署知情同意书。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及公开研究成果有关的利益冲突。

作者贡献声明：陶丽莹负责论文的课题设计，资料分析，论文撰写，收集数据；王宏光、周舰、郭庆梅、王曼彤负责手术的相关操作；郭享负责修改论文，指导撰写文章并最后定稿。

详细信息

通信作者:
郭享，18223115@qq.com

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出版历程
- 收稿日期: 2021-12-06
- 录用日期: 2022-01-10
- 出版日期: 2022-08-20

Efficacy of endoscopic retrograde cholangiopancreatography combined with SpyGlass system in treatment of acute cholecystitis secondary to choledocholithiasis

Department of Gastroenterology, Jilin City People's Hospital, Jilin, Jilin 132001, China

Research funding:

Jilin City Medical and Health Guidance Program (20210409008);

Jilin Provincial Health Science and Technology Capacity Building Program (2021LC120)

More Information

Corresponding author: GUO Xiang, 18223115@qq.com(ORCID: 0000-0003-0090-7772)

摘要

摘要: 目的比较内镜逆行胰胆管造影(ERCP)+SpyGlass系统和经皮胆囊穿刺引流术(PTGD)+ERCP治疗胆总管结石继发急性胆囊炎的安全性和有效性。方法回顾性分析2019年12月—2021年9月吉林市人民医院消化内科胆总管结石继发急性胆囊炎患者的临床资料，其中ERCP+SpyGlass组23例，PTGD+ERCP组19例，比较两组手术技术成功、手术操作时间、手术临床成功、手术后恢复情况、住院天数、并发症等指标。服从正态分布的计量资料组间比较采用两独立样本t检验；不符合正态分布组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ²检验或Fisher确切概率法。结果 ERCP+SpyGlass组较PTGD+ERCP组在术后CRP下降明显(Z=2.999, P=0.003)；两组的技术成功率(χ²=1.735，P=0.188)、临床成功率(χ²=0.846，P=0.358)、整体手术时间(t=1.667，P=0.113)、术后1 d白细胞计数(t=1.075，P=0.289)、术后住院天数(t=1.560，P=0.127)，以及并发症发生率比较，差异均无统计学意义(P值均＞0.05)。结论 ERCP+SpyGlass系统治疗对比PTGD+ERCP治疗胆总管结石继发急性胆囊炎，不增加手术相关不良事件和风险，治疗效果相当，安全有效，且一次性经内镜自然腔道解决胆道和胆囊问题，体表无瘢痕，术后护理便捷，值得临床进一步推广。
- 胆总管结石病 /
- 胆囊炎, 急性 /
- 胰胆管造影术, 内窥镜逆行 /
- SpyGlass系统
Abstract: Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)+SpyGlass system versus percutaneous transhepatic gallbladder drainage (PTGD)+ERCP in the treatment of acute cholecystitis secondary to choledocholithiasis. Methods A retrospective analysis was performed for the clinical data of the patients with acute cholecystitis secondary to choledocholithiasis who were treated in Department of Gastroenterology, Jilin City People's Hospital, from December 2019 to September 2021, among whom there were 23 patients in the ERCP+SpyGlass group and 19 patients in the PTGD+ERCP group. The two groups were compared in terms of the indicators such as surgical technical success, surgical operation time, surgical clinical success, postoperative recovery, length of hospital stay, and complications. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results Compared with the PTGD+ERCP group, the ERCP+SpyGlass group had a significant reduction in C-reactive protein after surgery (Z=2.999, P=0.003). There were no significant differences between the two groups in technical success rate (χ²=1.735, P=0.188), clinical success rate (χ²=0.846, P=0.358), total time of operation (t=1.667, P= 0.113), white blood cell count on day 1 after surgery (t=1.075, P= 0.289), length of postoperative hospital stay (t=1.560, P=0.127), and incidence rate of complications (all P > 0.05). Conclusion In the treatment of acute cholecystitis secondary to choledocholithiasis, the ERCP+SpyGlass system has a comparable clinical effect to PTGD+ERCP and is safe and effective, without increasing surgery-related adverse events and risks, and it can also solve the problems of the biliary tract and the gallbladder at one time through natural orifices, with no scars on body surface and convenient postoperative nursing. Therefore, it holds promise for clinical application.
- Choledocholithiasis /
- Cholecystitis, Acute /
- Cholangiopancreatography, Endoscopic Retrograde /
- SpyGlass System

HTML全文

图 1 ERCP+SpyGlass组操作流程

注：a，超声内镜提示胆总管下段结石；b，超声内镜提示胆囊壁呈双层结构，胆囊炎，胆囊内可见点絮状强回声；c，十二指肠镜下胆总管插管；d，取出胆总管结石；e，SpyGlass系统进入胆总管，可见胆囊管开口处脓液流出；f，导丝进入胆囊管，同时应用甲硝唑灌洗；g，SpyGlass系统沿着导丝从胆囊管进入胆囊，可见结石；h，将SpyGlass系统的网篮伸入胆囊；i，套取胆囊结石；j，SpyGlass系统沿着导丝进入胆囊；k，将胆囊结石取出；l，胆囊内留置鼻胆管进行引流。

Figure 1. ERCP+SpyGlass group operation process

下载: 全尺寸图片幻灯片

表 1 两组术前临床资料比较

Table 1. Comparison of preoperative clinical data between the two groups

项目	PTGD+ERCP组(n=19)	ERCP+SpyGlass组(n=23)	统计值	P值
年龄(岁)	76.16±7.60	73.04±6.50	t=1.432	0.160
男/女(例)	8/11	10/13	χ²=0.008	0.929
症状发作时间(d)	2(1~5)	3(1~11)	Z=1.218	0.223
白细胞(×10⁹/L)	13.01±5.34	12.07±1.88	t=0.735	0.470
CRP(mg/L)	18.0(6.5~184.0)	15.6(6.7~61.0)	Z=0.935	0.730
胆囊炎(双边征)[例(%)]	19(100)	23(100)	-	-
体温(≥38 ℃)[例(%)]	11(57.9)	7(30.4)	χ²=3.204	0.073

下载: 导出CSV

表 2 两组手术相关指标比较

Table 2. Comparison of surgery-related indicators between the two groups

项目	PTGD+ERCP组(n=19)	ERCP+SpyGlass组(n=23)	统计值	P值
胆囊支架[例(%)]	0	11(47.8)	χ²=12.311	＜0.001
技术成功[例(%)]	19(100)	21(91.3)	χ²=1.735	0.188
临床成功[例(%)]	19(100)	22(95.7)	χ²=0.846	0.358
PTGD或SpyGlass时间(min)	8.43±2.59	13.66±4.45	t=4.524	＜0.001
整体手术时间(min)	43.52±13.72	37.24±10.68	t=1.667	0.113
术后CRP(mg/L)	107.0(21.0~191.5)	13.6(6.6~28.0)	Z=2.999	0.003
术后1 d白细胞计数(×10⁹/L)	7.54±2.71	8.67±3.57	t=1.075	0.289
术后住院天数(d)	11.26±5.06	9.00±4.34	t=1.560	0.127
注：PTGD时间是指单独行PTGD手术的操作时间; SyGlass时间是指ERCP+SpyGlass系统治疗时从导丝进入胆囊管开始至胆囊灌洗后胆囊内置入鼻胆管结束的时间; 整体手术时间是指上述时间加上ERCP治疗的时间。

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