PTGD与ERCP在重症急性胆源性胰腺炎早期应用的临床疗效比较

Clinical observation of early percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography for severe acute biliary pancreatitis

目的比较早期应用经皮经肝胆囊穿刺引流术(PTGD)和内镜逆行性胰胆管造影术(ERCP)在重症急性胆源性胰腺炎(SABP)治疗中的临床价值。方法回顾性分析2014年3月至2018年3月辽宁省人民医院收治的69例SABP患者的临床资料,根据发病早期接受的不同治疗方式分为3组:PTGD组(n=22)、ERCP组(n=27)、保守组(n=20)。比较治疗前后实验室指标及临床评分变化,比较实验室指标恢复正常的时间及腹痛消失时间、体温恢复正常时间、经口进食时间、住院时间,比较并发症发生率以及死亡率。结果 PTGD组、ERCP组分别与保守组相比,治疗3天的实验室指标:WBC、CRP、AMS、TBIL、ALT均下降显著,差异具有统计学意义(P均<0.05);治疗1周的临床评分:APACHEⅡ评分、改良Marshall评分、CTSI评分均下降显著,差异具有统计学意义(P均<0.05);WBC、CRP、AMS、TBIL、ALT恢复正常的时间短;腹痛消失时间、体温恢复正常时间、经口进食时间及住院时间也均比保守组短,差异均有统计学意义(P均<0.05);全身并发症:全身炎症反应综合征(SIRS)、多器官功能障碍综合征(MODS)、上消化道出血、脓毒症发生率及死亡率比保守组低,差异有统计学意义(P均<0.05)。ERCP组与PTGD组相比,治疗3天的TBIL下降程度以及恢复正常时间更短,差异具有统计学意义(P<0.05),经口进食时间及住院时间也短于PTCD组(P<0.05)。结论 SABP患者早期应用PTGD和ERCP均可获益,PTGD与ERCP相比在重要结果如并发症和死亡率方面无明显差异,PTGD可作为ERCP失败或无法耐受时的替代疗法,值得临床推广。

Objective To investigate the clinical effect of early percutaneous transhepatic gallbladder drainage (PTGD) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of severe acute biliary pancreatitis (SABP).Methods A retrospective analysis was performed in 69 patients with SABP treated in the People′s Hospital of Liaoning Province from March 2014 to March 2018.According to the treatment methods received in the early stage of the disease,the patients were divided into three groups:PTGD group ( n =22),ERCP group ( n =27) and conservative group ( n =20).Laboratory indexes and clinical scores before and after treatment and the time of laboratory indexes back to normal,disappearance of abdominal pain,body temperature returning to normal,oral feeding,hospitalization were compared among there groups.And the incidence of complications and mortality in each group were observed.Results Compared to conservative group,the laboratory indexes(WBC,CRP,AMS,TBIL,ALT)were significantly decreased ( P <0.05) in PTGD group and ERCP group after 3 days of treatment.The clinical scores(APACHE II score,modified Marshall score and CTSI score)were significantly decreased ( P <0.05) after 1 week of treatment.The times of laboratory indexes back to normal,disappearance of abdominal pain,body temperature returning to normal,oral feeding and hospitalization were significantly shorter ( P <0.05).The incidence of systemic complications (SIRS,MODS,upper gastrointestinal hemorrhage,sepsis) and mortality rate were significantly lower ( P <0.05).Compared with PTGD group,TBIL in ERCP group decreased more significantly after 3 days of operation,and the time back to normal was shorter ( P <0.05).The time of oral feeding and hospitalization were shorter ( P <0.05).Conclusion Early treatment with PTGD and ERCP is beneficial for patients with SABP,and there is no significant difference between PTGD and ERCP in the critical outcomes such as complications and mortality.PTGD can be used as an alternative treatment for patients with SABP who have failed ERCP or are unable to tolerate ERCP and thus is worth clinical promotion.