摘要
目的探讨急性梗阻化脓性胆管炎(AOSC)的内镜治疗及细菌感染对预后的影响,为临床合理指导AOSC患者的内镜下治疗提供更多循证医学证据。方法选取2013年1月-2016年10月医院收治的AOSC患者310例;依据手术方式不同,分为内镜组140例和对照组170例;内镜组患者行逆行胰胆管造影(ERCP)配合内镜鼻胆管引流术(ENBD);对照组患者行传统手术治疗(胆管切开减压+T管引流术),比较两组患者的临床疗效,细菌感染的病原学分布特点及对预后的影响。结果两组患者在性别、年龄、发病至就诊时间和术前肝功指标上比较差异均无统计学意义;内镜组患者的治愈率为94.28%,显著高于对照组的87.64%;内镜组患者黄疸减轻时间、腹痛缓解时间、引流管拔除时间及总住院时间均短于对照组,差异有统计学意义(P<0.05);与术前相比,术后两组患者肝功丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)明显降低,白蛋白(ALB)水平显著升高(P<0.05);炎症因子超敏C-反应蛋白(hs-CRP)水平显著下降(P<0.05);且术后内镜组ALT、AST和hs-CRP水平与对照组比较,差异均有统计学意义(P<0.05)。结论内镜治疗AOSC患者的疗效优于传统手术治疗,合并细菌感染的病原菌分布特点并非影响患者手术方式及预后的主要因素。
OBJECTIVE To explore the effect of endoscopy on acute obstructive suppurative cholangitis （AOSC）and observe the influence of bacterial infections on prognosis so as to provide evidence-based medical basis for treatment of AOSC patients with endoscopy.METHODS A total of 310 AOSC patients who were treated in the hospital from Jan 2013 to Oct 2016 were enrolled in the study and were divided into the endoscopy group with 140 cases and the control group with 170 cases according to the surgical approach.The endoscopy group was treated with endoscopic retrograde cholangiopancreatography （ERCP） combined with endoscopic nasobiliary drainage （ENBD）,while the control group was given conventional surgical procedures （biliary ducts open decompression plus T tube drainage）.The clinical effect of the two groups was compared,and we also analyzed the distribution characteristic of etiology of bacterial infections and its influence on prognosis.The clinical effect was compared between the two groups of patients,and the characteristics of etiological distribution of bacterial infections and the influence on prognosis were observed.RESULTS There was no significant difference in the genders,age,interval between attack of disease and treatment,or preoperative liver function indexes between the two groups of patients.The cure rate of the endoscopy group was 94.28%,significantly higher than 87.64% of the control group.The time of relief of jaundice,time of remission of abdominal pain,time of removal of drainage tube,and total hospitalization duration were significantly shorter in the endoscopy group than in the control group（P〈0.05）.The levels of alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,and serum total bilirubin （TBIL） of the two groups of patients were significantly lower after the surgery than before the surgery（P〈0.05）,and the albumin （ALB） level was significantly elevated （P〈0.05）.The inflammatory factor high-sensitivity C-reactive protein （hs-CRP） level wa
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第10期2275-2278,共4页
Chinese Journal of Nosocomiology
基金
浙江省医学会临床科研基金资助项目(2011ZYC-A02)
关键词
急性梗阻化脓性胆管炎
病原菌
内镜
肝脏功能
Acute obstructive suppurative cholangitis
Pathogen
Endoscope
Liver function
