经皮肝胆管引流术与经内镜鼻胆管引流术对急性梗阻性化脓性胆管炎的疗效对比研究

The efficacy of percutaneous transhepatic cholangiograph drainage and endoscopic nasobiliary drainage for acute obstructive suppurative cholangitis

目的探讨经皮肝胆管引流术(Percutaneous transhepatic cholangiograph drainage,PTCD)与经内镜鼻胆管引流术(Endoscopic Nasobiliary Drainage,ENBD)对急性梗阻性化脓性胆管炎的疗效差异。方法选取本院2010年1月至2015年1月期间肝胆外科住院部急性梗阻性化脓性胆管炎患者134例,根据不同的手术方法将患者分为观察组与对照组,各67例,对照组患者采用经皮肝胆管引流术;观察组患者采用经内镜鼻胆管引流术,比较两组临床疗效。结果观察组治疗总有效率明显高于对照组,两组比较差异具有统计学意义(P<0.05),且与对照组比较,观察组患者术后5 d血清胆红素水平明显降低(P<0.05),腹痛缓解时间与住院时间明显缩短(P<0.05),住院费用明显减少(P<0.05)。观察组黄疸改善率明显高于对照组,总并发症发生率明显低于对照组,两组比较差异具有显著性(P<0.05)。结论经内镜鼻胆管引流术对急性梗阻性化脓性胆管炎的疗效更显著,有助于有效缓解临床症状,缩短病程,降低并发症风险,值得临床推广应用。

Objective Investigating the therapeutic effects of percutaneous transhepatic cholangiograph drainage（ PTCD） and endoscopic nasobiliary drainage（ ENBD） in the treatment of acute obstruction suppurative cholangitis. Methods 134 cases of acute obstructive suppurative cholangitis patients were selected, they hospitalized in hepatobiliary and pancreatic surgery department of our hospital from January 2010 to January 2015.According to the different surgical methods,all the patients were divided into observation group and control group,67 cases in each. The control group was treated by PTCD while the observation group was treated by ENBD and the clinical therapeutic effects of two groups were compared. Results The total effective rate of observation group was significantly higher than that of control group,and the difference between the two groups was statistically significant（ P〈 0. 05）. Compared with the control group,the serum level of bilirubin was significantly decreased5 days after the operation（ P〈 0. 05）. The time for abdominal pain relief and hospitalization time were significantly shortened（ P〈 0. 05）,and the hospitalization expense was significantly reduced（ P〈 0. 05）. The improvement rate of jaundice in the observation group was significantly higher than that in the control group and the incidence rate of total complications was significantly lower than that of the control group,the differences between the two groups were statistically significant（ P〈 0. 05）. Conclusions The therapeutic effect of ENBD is more significant for acute obstructive suppurative cholangitis,and it is helpful to alleviate the clinical symptoms,shorten the course of disease,reduce the complications risk,it is worthy of clinical application.