摘要
目的探讨经皮肝胆管穿刺引流术(PTCD)联合内镜逆行胰胆管造影术(ERCP)治疗梗阻性化脓性胆管炎(AOSC)的临床效果。方法选取54例AOSC患者,根据治疗方法不同分为对照组(n=24)和观察组(n=30)。对照组患者行胆管切开减压联合T管引流术;观察组患者行PTCD联合ERCP治疗。观察2组患者术前、术后丙氨酸氨基转移酶(ALT)、总胆红素水平变化,休克、精神症状改善情况,病死率、并发症发生率及住院时间。结果 2组患者术前2 h总胆红素、ALT水平比较差异无统计学意义(P>0.05)。术后2、72 h及1、2周,观察组患者总胆红素、ALT水平低于对照组(P<0.05)。术后24 h,观察组患者感染性休克改善率高于对照组(P<0.05),神经系统受抑制改善率与对照组比较差异无统计学意义(P>0.05);术后72 h,2组患者感染性休克、神经系统受抑制改善率比较差异均无统计学意义(P>0.05)。观察组患者病死率、并发症发生率均低于对照组(P<0.05),住院时间短于对照组(P<0.05)。结论 PTCD联合ERCP治疗AOSC可迅速改善患者ALT、总胆红素水平、精神及休克症状,降低并发症的发生和病死率,缩短住院时间。
Objective To investigate the curative effect of percutaneous transhepaticcholangial drainage（ PTCD） combined with endoscopic retrograde cholangiopancreatography（ ERCP） for treating acute obstructive suppurative cholangitis（ AOSC）. Methods Fifty-four patients with AOSC were divided into control group（ 24 cases） and observation group（ 30 cases） according to the different therapy. The control group was given bile duct incision decompression combined with T tube drainage. The observation group was treated with PTCD combined with ERCP. The level of alanine aminotransferase（ ALT） and total bilirubin was observed before and after operation. The improvement of shock and mental symptoms,mortality,complication rate and hospitalization time were also observed. Results There was no significant difference in level of ALT and total bilirubin between the two groups before operation（ P〈0. 05）. The level of ALT and total bilirubin in observation group at 2,72 hours,one week and two weeks after operation was lower than that in control group（ P〈0. 05）. Improvement rate of infectious shock in observation group at 24 hours after operation was higher than that in control group（ P〈0. 05）,but there was no significant difference in improvement rate of nervous system suppression between the two groups（ P〈0. 05）. There was no significant difference in improvement rate of infectious shock and nervous system suppression at 72 hours after operation between the two groups（ P〈0. 05）. Mortality,complication rate and hospitalization time in observation group were lower than those in control group（ P〈0. 05）. Conclusion The therapy of PTCD combined with ERCP for AOSC can improve the level of ALT and total bilirubin,the symptom of infectious shock and nervous system suppression rapidly,reduce the concurrent rate and mortality,shorten the time of hospitalization.
出处
《新乡医学院学报》
CAS
2015年第7期660-662,共3页
Journal of Xinxiang Medical University
关键词
梗阻性化脓性胆管炎
经皮肝胆管穿刺引流术
内镜
acute obstructive suppurative cholangitis
percutaneous transhepatic puncture drainage
endoscopic
