胆囊穿刺置管引流术联合经鼻空肠营养管治疗急性重症胆源性胰腺炎的临床价值

The clinical value of gallbladder drainage combined with nasal jejunum nutrition tube in the treatment of severe acute biliary pancreatitis

目的观察经皮经肝胆囊穿刺置管引流术联合经鼻空肠营养管置入术治疗急性重症胆源性胰腺炎的临床价值。方法回顾性分析2014年9月至2017年12月在我院诊断急性重症胆源性胰腺炎并在48 h内采取经皮经肝胆囊穿刺置管引流术联合经鼻空肠营养管置入术后12例患者,观察患者术前1 d、术后1周体温(T)、脉搏(P)、呼吸(R)、血压(BP)、腹部疼痛情况、上腹部CT检查及白细胞总数(WBC)、C-反应蛋白(CPR)、白介素6(IL-6)、降钙素原(PCT)、总胆红素(TBIL)、直接胆红素(DBIL)、血清总蛋白(TP)、转铁蛋白(Tf)、白蛋白(ALB)、血钙(Ca)等指标变化情况。结果患者接受经皮经肝胆囊穿刺置管引流术联合经鼻空肠营养管置入术后1周腹痛减轻,T、P、R及BP恢复正常,WBC、CPR、IL-6、PCT、TBIL、DBIL均较术前1d降低,TP、Tf、ALB及Ca较术前1 d升高,VAS、CTSI及APACHE-Ⅱ评分减少( P <0.05),1周内患者死亡率为0。结论胆囊穿刺置管引流术联合经鼻空肠营养管置入术可有效引流胆汁,减少感染机会,避免胰腺炎引起的多器官功能损伤;加强肠内营养支持,减少胰液分泌在急性重症胆源性胰腺炎治疗中发挥重要作用。

Objective To observe the clinical value of percutaneous transhepatic gallbladder drainage (PTGD) combined with naso-jejunal feeding tube placement (NFTP) in the treatment of acute severe biliary pancreatitis (ASBP). Methods The clinical data of 12 patients with ASBP diagnosed in our hospital and treated with PTGD plus NFTP within 48 hours were retrospectively analyzed,from September 2014 to December 2017,including the temperature,pulse,respiration,blood pressure,abdominal pain,upper abdominal CT and WBC,CPR,IL-6,PCT,TBIL,DBIL,TP,Tf,ALB,Ca at 1 day before operation and the changes at 1 week after operation. Results At a week after PTGD plus NFTP,the abdominal pain of all patients’ was alleviated,the temperature,respiration,pulse and blood pressure returned to normal,the levels of WBC,CPR,IL-6,PCT,TBIL,DBIL were lower than that on the 1 day before operation,the levels of TP,Tf,ALB and Ca were higher than that on the 1 day before operation,and the score of VAS,CTSI and APACHE-Ⅱ were decreased ( P <0.05).Eventually,the mortality of ASBP patients was 0% within 1 week. Conclusion PTGD plus NFTP can effectively drain the bile,reduce the chance of infection,avoid the damage to multiple organs caused by pancreatitis,and strengthen enteral nutrition.Thus,reduction of pancreatic secretion plays an important role in the treatment of ASBP.