胆道积气的预后因素及治疗对策

Prognostic factors and treatment strategies of pneumobilia

目的探讨胆道积气的预后因素及治疗对策。方法收集2010年1月至2013年12月于北京大学第一医院经CT诊断的64例胆道积气患者的临床资料，包括年龄、病史、入院时血清碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、总胆红素水平及凝血酶原时间（PT）等实验室检查指标。根据临床转归结果，将胆道术后胆道积气患者分为缓解组（23例）和不缓解组（25例），分析影响胆道积气转归的因素。对未经胆道手术胆道积气患者仅行描述性分析。结果64例患者中男46例，女18例；48例曾经胆道手术，手术种类包括胆肠吻合术（22例）、胆囊切除合并胆总管探查术（10例）、内镜下括约肌切开取石术（3例）、内镜下胆道支架置入术（3例）、胰十二指肠切除术（10例）；16例未经胆道手术，其中胆道肿瘤6例，胆管结石3例，肝脓肿3例，胆管炎性狭窄2例，胆管十二指肠瘘1例，坏死性肠炎1例。2组患者中ALP、GGT、总胆红素异常及胛延长者占比差异均有统计学意义（P=0．000、0．001、0．036和0．025）；总胆红素水平升高是影响胆道术后患者胆道积气转归的独立危险因素；未经胆道手术患者出现胆道积气时，要警惕胆道肿瘤、肠坏死等少见情况。结论胆道术后患者胆道积气较为常见，当患者伴随黄疸时应加以重视；未经胆道手术的患者出现胆道积气时，应仔细检查寻找原因。

Objective To investigate the prognostic factors and treatment strategies of pneumobilia. Methods The clinical data, including age, medical history, alkaline phosphatase （ALP） , glutamyl transpetidase （GGT） , total bilirubin and prothrombin time （PT） of 64 patients with pneumobilia confirmed by CT scan in Peking University First Hospital from January 2010 to December 2013 were retrospectively analyzed. According to the clinical outcomes, the patients with biliary surgery were divided into remission group （23 cases） and non-remission group （22 cases） ; the prognostic factors of pneumobilia were analyzed. The descriptive study was used to analyze the pneumobilia patients without choledochotomy. Results Among the 64 cases, 46 were male and 18 were female. Forty eight patients underwent surgical procedures, including choledoehojejunostomy （22 cases ） , chole-cystectomy with common bile duct exploration （10 cases）, endoscopic sphincterotomy （3 cases）, endoscopic sphincterotomy with stent implantation （3 cases） and whipple procedure （10 cases）. Sixteen pneumobilia cases without surgery history turned out to have Inflammatory bile duct stenosis （2 cases）, biliary tumor （6 cases）, choledocholithiasis （3 cases） , liver abscess （3 cases）, biliary duodenal fistula （1 case） and necrotizing enterocolitis （1 case）. Among patients after biliary operations, there were significant differences of ALP, GGT, total bilirubin and rate of prolonged prothrombin time between remission group and non-remission group （ P = 0. 000, 0. 001, 0. 036, 0. 025 ）. Increase of total bilirubin was an independent risk factor of pneumobilia after biliary surgery. For patients without surgery, pneumobilia was related to rare circumstances such as biliary tumor or bowel necrosis. Conclusions Pneumobilia is common after hiliary surgery, which should be paid more attention when jaundice is accompanied. The causes should be looked for in patients of pueumobilia without surgery.