不同引流术对急性梗阻性化脓性胆管炎的疗效观察

Different drainage curative effects of acute obstructive suppurative cholangitis

目的探讨内镜鼻胆管引流术与经皮肝穿刺胆道引流术治疗急性梗阻性化脓性胆管炎的临床疗效.方法选择2012年1月~2015年12月在我科治疗的164例急性梗阻性化脓性胆管炎患者,根据引流方式不同分为对照组和观察组,对照组采用经皮肝穿刺胆道引流术共81例,观察组采用内镜鼻胆管引流术共83例,观察两组患者治疗有效率、临床指标及并发症发生率.结果观察组患者的治疗有效率为91.57%,对照组患者的治疗有效率为90.12%,虽然观察组的有效率高于对照组,但不具有统计学意义(P>0.05);比较两组患者术后7d临床症状,观察组患者的血清总胆红素水平(62.54±11.23)μmol/L、腹痛缓解时间(5.67±1.16)d、住院时间(10.56±3.29)d均明显低于对照组的(79.36±17.68)μmol/L、(7.54±1.43)d、(16.82 ±4.71)d(P <0.05);观察组患者的引流量(343.18±53.46) ml/d明显高于对照组(312.45±51.27)ml/d(P >0.05);观察组的不良反应发生率为6.02%明显低于对照组的16.05%(P <0.05).结论内镜鼻胆管引流术与经皮肝穿刺胆道引流术在治疗急性梗阻性化脓性胆管炎方面均疗效显著,但内镜鼻胆管引流术操作简单,缓解症状更快,术后并发症更少,安全性更高.

Objective To study the endoscopic nasal biliary drainage and percutaneous liver puncture biliary drainage clinical curative effect for the treatment of acute obstructive suppurative cholangitis. Methods January 2012 - December 2015 in our department for the treatment of 164 cases of patients with acute obstructive suppurative cholangitis, according to different drainage ways were divided into control group and observation group, control group using percutaneous liver puncture biliary drainage, 81 cases, observation group with a total of 83 cases of endoscopic nasal biliary drainage, observe two groups of patients effectively, clinical indicators and complication rates. Results Compare two groups of patients with postoperative clinical symptoms, 7 d observation group of patients with serum total bilirubin level (62. 54 ± 11. 23)μmol / L, abdominal pain relief time of (5. 67 ± 1. 16) d, and the length of time for (10. 56 ± 3. 29) d were significantly lower than in the control group (79. 36 ± 17. 68)μmol /L、( 7. 54 ± 1. 43) d、( 16. 82 ±4. 71) d( P <0. 05 );drainage observation group were (343. 18 ± 53. 46) ml/d was significantly higher (312. 45 ± 51. 27) ml / d ( P > 0. 05 );The incidence of adverse reactions was 6. 02% of observation group was obviously less than 16. 05% in the control group ( P < 0. 05 ). Conclusion Endoscopic nasal biliary drainage and percutaneous liver puncture biliary drainage in the treatment of acute obstructive suppurative cholangitis curative effect is distinct, but endoscopic nasal biliary drainage operation simple, relieve symptoms, faster, less postoperative complications, higher security.