胃镜引导下十二指肠胆汁引流术在重型肝炎合并胆道感染中的临床价值

Clinical value of duodenal bile drainage with gastroscope in severe hepatitis complicated with biliary tract infections

目的分析探讨胃镜引导下十二指肠胆汁引流术在重型肝炎合并胆道感染中的临床价值。方法选取医院2009年10月-2010年10月收治的重型肝炎合并胆道感染患者100例,随机分为观察组与对照组;观察组60例,采用胃镜引导下十二指肠胆汁引流术治疗;对照组40例,采用传统引流术治疗;对比两组的引流成功率、引流用时、不适反应、血红素降低水平。结果观察组的引流成功率为98.33%,明显优于对照组的80.00%(P<0.05);观察组的引流用时间为(26.28±4.29)min,明显短于对照组的(134.77±24.31)min(P<0.05);观察组患者的不良反应明显轻于对照组(P<0.05);重型肝炎合并胆道感染以革兰阴性菌为主,对头孢他啶、哌拉西林/他唑巴坦等药物的敏感性较高;真菌感染以白色假丝酵母菌为主,对伊曲康唑、两性霉素、氟康唑等药物的敏感性较高;治疗两周后,观察组的血红素水平降低有效率为70.00%,明显高于对照组的52.50%(P<0.05)。结论胃镜引导下十二指肠胆汁引流术的疗效显著,且用时短,安全性高,值得临床广泛推广。

Abstract： OBJECTIVE To explore clinical value of duodenal bile drainage with gastroscope in the severe hepatitis with biliary infections. METHODS A total of 100 cases of patients with severe hepatitis with biliary infections were divided into two groups according to the different treatment methods. The research group （n=60） was treated with the duodenal bile drainage with gastroscope, and the control group （n=40） was treated with the traditional drainage treatment, The success rate of drainage, time of drainage, adverse reactions, and decrease of hemoglobin level between the two groups were compared . RESULTS The success rate of drainage of the research group was 98.33%, obviously higher than 80.00% of the control group （P〈0. 05 ）. Tbe drainage time of the research group was （26. 28 ± 4. 29） min, significantly shorter than （134. 77±24. 31） min of the control group, （P〈0.05）. The adverse reactions were significantly less in the research group than in the control group （P〈0.05）. The gram-negative bacteria were the main pathogens causing the severe hepatitis complicated with the biliary tract infections and were highly sensitive to ceftazidime and tazobactam/piperacillin. Candicla albicans was the main species of fungi causing infections and was highly sensitive to itraconazole, amphotericin, and fluconazole. Two weeks after the treatment, the effective rate of decrease of hemoglobin level was 70.00M in the research group, significantly higher than 52.50% in the control group （P〈0.05）. CONCLUSION Duodenal bile drainage with gastroscope can achieve significant clinical efficacy, with shorter drainage time and higher safety,thus it is worthy of the wide promotion in the hospital.