Selection of treatment regimens for pancreatic duct stones: A comparative analysis
10.3969/j.issn.1001-5256.2022.11.023
- VernacularTitle:胰管结石治疗方案的选择分析与比较
- Author:
Jinbin DONG
1
;
Weibing FANG
2
;
Yihai SHI
1
Author Information
1. Department of Gastroenterology, Gongli Hospital Affiliated to Naval Medical University, Shanghai 200135, China
2. Department of Medical Ultrasonics, Chizhou Second Hospital, Chizhou, Anhui 247100, China
- Publication Type:Original Articles_Pancreatic Diseases
- Keywords:
Pancreatic Duct Stones;
Cholangiopancreatography, Endoscopic Retrograde;
Laparoscopy;
Digestive System Surgical Procedures
- From:
Journal of Clinical Hepatology
2022;38(11):2558-2564
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and laparotomy in the treatment of pancreatic duct stones (PDS) by collecting related clinical data, to summarize the experience in selecting treatment regimens for PDS, and to further explore feasible treatment regimens that could maximize and optimize the benefits of PDS patients. Methods A retrospective analysis was performed for the clinical data of 131 PDS patients who were treated in Gongli Hospital Affiliated to Naval Medical University from June 2014 to December 2018, and according to the surgical procedure, they were divided into ERCP group with 69 patients, laparoscopy group with 32 patients, and laparotomy group with 30 patients. Related indices were monitored before and after treatment, and surgical outcome was compared between the laparoscopy group and the laparotomy group. The independent samples t -test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t -test or the SNK- q test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. An repeated measures analysis of variance and the Friedman test were used for comparison of related indices before and after surgery, and the chi-square test was used for comparison of categorical data between groups. Results Among the 131 PDS patients, there were 40 patients with type Ⅰ PDS, 76 with type Ⅱ PDS, and 15 with type Ⅲ PDS. There was no significant difference in the distribution of main surgical methods between the laparoscopy group and the laparotomy group ( χ 2 =1.93, P > 0.05). There were significant differences between the laparoscopy group and the laparotomy group in the dynamic changes of white blood cell count, C-reactive protein, procalcitonin, and Homeostasis Model Assessment of Insulin Resistance after surgery ( F =24.68, χ 2 =227.66, F =45.37, F =106.71, all P < 0.05). Compared with the laparotomy group, the laparoscopy group had significantly shorter time of operation, significantly lower intraoperative blood loss, significantly shorter time to first flatus after surgery, a significantly lower frequency of use of pain-relieving drugs, shorter time to extraction of abdominal drainage tube, lower incidence rates of short-term postoperative complications, and a significantly shorter length of postoperative hospital stay ( t =-4.80, t =-9.43, Z =-6.78, t =-11.59, Z =-6.77, χ 2 =9.24, t =-3.60, all P < 0.05). The incidence rate of short-term postoperative complications was 24.64% in the ERCP group, 28.13% in the laparoscopy group, and 66.67% in the laparotomy group, with a significant difference between groups ( χ 2 =17.12, P < 0.05), and the ERCP group and the laparoscopy group had a significantly lower incidence rate of short-term postoperative complications than the laparotomy group ( χ 2 =15.78 and 9.24, P < 0.05 and P =0.02). The treatment response rate was 91.30% in the ERCP group, 93.75% in the laparoscopy group, and 73.33% in the laparotomy group, with a significant difference between the three groups ( χ 2 =7.70, P =0.02), and the ERCP group and the laparoscopy group had a significantly better response rate than the laparotomy group ( χ 2 =5.56 and 4.77, P =0.02 and 0.03). Conclusion ERCP is the preferred method for minimally invasive treatment of some patients with type Ⅰ/Ⅱ PDS and is safe and effective with few serious complications. Surgical operation is an important method for the treatment of complex PDS, but with complicated techniques and difficult operation. Compared with laparotomy, laparoscopy has the advantages of small trauma, few serious complications, and high abdominal pain remission rate and can significantly shorten the time of operation, reduce intraoperative blood loss, and shorten the length of postoperative hospital stay. Therefore, laparoscopy should be the preferred regimen for the treatment of complex PDS.
