双镜联合治疗急性胆源性胰腺炎合并胆囊结石的临床疗效OACSTPCD

Objective To investigate the clinical efficacy of combined double-mirror treatment of patients with acute biliary pancreatitis combined with cholecystolithiasis and its effects on amylase(AMS),high-sensitivity C-reactive protein(hs-CRP),macrophage inflammatory protein-1β(MIP-1β)and oxidative stress.Methods 102 patients with acute biliary pancreatitis with cholecystolithiasis from January 2017 to December 2021 were selected and divided into the double-mirror group(63 cases)and the open group(39 cases)according to different surgical modalities;the double-mirror group underwent double mirror combination(laparoscope and choledochoscope)treatment,and the open group underwent open cholecystectomy combined with choledochotomy for lithotripsy,and the two groups were compared for the recovery indexes and clinical efficacy,pain visual analogue scale(VAS),MIP-1β,hs-CRP,AMS,oxidative stress indicators and complication rate.Results Intraoperative bleeding was less than that of the open group in the double-mirror group,anal defecation time,abdominal symptom relief time and hospitalization time were shorter than those of the open group,and the overall effective rate was higher than that of the open group,and the differences were all statistically significant(P＜0.05).Repeated-measures ANOVA results showed that the time-point,between-group and interaction effects of VAS in the two groups were compared,and the differences were statistically significant(P＜0.05);the VAS of patients in the two groups at 1 and 7 d postoperatively was lower than that of preoperative,and it was lower in the double-mirror group than that of the open group,and the differences were all statistically significant(P＜0.05).The MIP-1β,hs-CRP and AMS of patients in both groups at 7 d postoperatively were lower than those of preoperative,and the double-mirror group was lower than that of the open group,and the differences were statistically significant(P＜0.05).Superoxide dismutase(SOD),advanced oxidized protein products(AOPPs),malonaldehyde(MDA)and glutathione peroxidase(GSH-Px)in the double-mirror group were not statistically significant at 7 d postoperatively compared with those in the preoperative group(P＞0.05);however,SOD and GSH-Px were higher than those of the open group in the double-mirror group at 7 d postoperatively,and AOPPs and MDA were lower than those of the open group,and the differences were all statistically significant(P＜0.05).The total complication rate of double-mirror group was lower than that of open group(4.76%and 25.64%),and the difference was statistically significant(P＜0.05).Conclusion For patients with acute biliary pancreatitis with cholecystolithiasis,double-mirror combined treatment can achieve ideal clinical results,effectively relieve postoperative pain,improve serum MIP-1β,hs-CRP and AMS indexes,regulate oxidative stress,reduce the risk of postoperative complications and promote postoperative recovery.