经内镜胆道内支架放置术和鼻胆管引流术治疗各级急性胆管炎的效果比较

Comparison between endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage in treatment of acute cholangitis

目的比较经内镜胆道内支架放置术(ERBD)和经内镜鼻胆管引流术(ENBD)对各级急性胆管炎的治疗效果。方法回顾性分析2009年1月至2017年6月在北京朝阳医院接受急诊经内镜逆行胰胆管造影术(ERCP)治疗的272例急性胆管炎患者资料,其中ERBD组143例,包括Ⅰ级(轻度)急性胆管炎63例,Ⅱ级(中度)51例,Ⅲ级(重度)29例;ENBD组129例,包括Ⅰ级(轻度)54例,Ⅱ级(中度)37例,Ⅲ级(重度)38例。分别比较两组总体患者和各级急性胆管炎患者的炎症缓解率、ERCP相关并发症发生率和引流干预率。结果ERBD组和ENBD组总体炎症缓解率[89.5%(128/143)比94.6%(122/129),χ^2=2.399,P=0.126]及Ⅰ级[93.7%(59/63)比98.1%(53/54),χ^2=0.548,P=0.459]、Ⅱ级[90.2%(46/51)比94.6%(35/37),χ^2=0.125,P=0.724]、Ⅲ级患者炎症缓解率[79.3%(23/29)比89.5%(34/38),χ^2=0.657,P=0.418]比较,差异均无统计学意义。ERBD组和ENBD组总体并发症发生率[11.9%(17/143)比7.8%(10/129),χ^2=1.298,P=0.255]及Ⅰ级[9.5%(6/63)比7.4%(4/54),χ^2=0.006,P=0.939]、Ⅱ级[13.7%(7/51)比8.1%(3/37),χ^2=0.230,P=0.632]、Ⅲ级患者并发症发生率[13.8%(4/29)比7.9%(3/38),χ^2=0.144,P=0.705]比较,差异均无统计学意义。ERBD组和ENBD组总体引流干预率比较差异有统计学意义[10.5%(15/143)比3.1%(4/129),χ^2=5.699,P=0.017],Ⅰ级[6.3%(4/63)比1.9%(1/54),χ^2=0.548,P=0.459]、Ⅱ级患者引流干预率[9.8%(5/51)比5.4%(2/37),χ^2=0.125,P=0.724]比较差异无统计学意义,但Ⅲ级患者比较差异有统计学意义[20.7%(6/29)比2.6%(1/38),χ^2=3.965,P=0.046]。结论ENBD与ERBD对各级急性胆管炎的治疗具有相同的效果,但ENBD能够降低术后引流干预率。

ObjectiveTo compare the safety and effectiveness of endoscopic retrograde biliary drainage(ERBD)and endoscopic nasobiliary drainage(ENBD)in treatment of acute cholangitis.MethodsA retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography(ERCP)in Beijing Chaoyang Hospital from January 2009 to June 2017.Patients were divided into ERBD group(n=143)and ENBD group(n=129)according to the drainage measures.In the ERBD group,there were 63 cases of gradeⅠ(mild)acute cholangitis,51 of gradeⅡ(moderate),and 29 of gradeⅢ(severe),and the corresponding cases in the ENBD group were 54,37 and 38,respectively.The rate of improvement of inflammation,ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade.ResultsThe rates of improvement of inflammation in the ERBD group and the ENBD group were 89.5%(128/143)and 94.6%(122/129),respectively,in overall patients(χ^2=2.399,P=0.126),93.7%(59/63)and 98.1%(53/54),respectively,in gradeⅠpatients(χ^2=0.548,P=0.459),90.2%(46/51)and 94.6%(35/37),respectively,in gradeⅡpatients(χ^2=0.125,P=0.724),and 79.3%(23/29)and 89.5%(34/38),respectively,in gradeⅢpatients(χ^2=0.657,P=0.418).The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11.9%(17/143)and 7.8%(10/129),respectively,in overall patients(χ^2=1.298,P=0.225),9.5%(6/63)and 7.4%(4/54),respectively,in gradeⅠpatients(χ^2=0.006,P=0.939),13.7%(7/51)and 8.1%(3/37),respectively,in gradeⅡpatients(χ^2=0.230,P=0.632),and 13.8%(4/29)and 7.9%(3/38),respectively,in gradeⅢpatients(χ^2=0.144,P=0.705).There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups.The incidences of interventions to drainage in the ERBD group and the ENBD group were 10.5%(15/143)and 3.1%(4/129),respectively,in overall patients(χ^2=5.699,P=0.017),6.3%(4/63)and 1.9%(1/54),respectively,in gradeⅠpatients(χ^2=0.548,P=0.495),9.8%(5/51)and 5.4%(2/37),respectively,in gradeⅡpatients(χ^2=0.125,P=0.724),and 20.7%(6/29)and 2.6%(1/38),respectively,in gradeⅢpatients(χ^2=3.965,P=0.046).There were significant differences in the incidence of interventions to drainage between the two groups in overall and gradeⅢpatents.ConclusionERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis,but ENBD can reduce the incidence of interventions to drainage.