CO2联合造影剂造影在肝门部胆管癌内镜引流中的价值

Value of radiography with CO2 combined with contrast agents in endoscopic drainage for hilar cholangiocarcinoma

目的探讨C02联合造影剂造影在不可切除的肝门部胆管癌内镜引流中的价值。方法回顾性分析兰州大学第一医院2010年10月至2015年10月间行内镜引流术治疗的43例不可切除的肝门部胆管癌患者病例资料,根据造影剂选用分为研究组(CO2联合造影剂造影)和对照组(单纯造影剂造影)。研究组23例,对照组20例,比较两组术后总胆红素、白细胞计数、降钙素原及并发症发生率等指标。结果43例患者内镜操作时间50-70min,术后研究组48h和72h的总胆红素、白细胞、降钙素原均低于对照组[48h总胆红素:(173.42±66.78)μmol/L比(210.81±78.34)μmol/L,P=0.025;72h总胆红素:(104.64±56.35)μmol/L比(159.33±59.59)μmol/L,P=0.023;48h白细胞:(11,51±7.78)x10^9/L比(15.83±6.67)x10^9/L,P=0.026,72h白细胞:(10.92±5.64)x10^9/L比(14.72±4.97)x10^9/L,P=0.026;48h降钙素原:(0.56±0.18)ng/mL比(1.24±0.73)ng/mL,P=0.003;72h降钙素原:(0.42±0.27)ng/mL比(0.90±0.20)ng/mL,P=0.001]o术后胆管炎的发生率研究组低于对照组,差异有统计学意义[13.0%(3/23)比40.0%(8/20),P=0.043];两组术后胰腺炎的发生率均较低,差异无统计学意义[4.3%(1/23)比10.0%(2/20)/=0.090]。结论不可切除的肝门部胆管癌内镜引流中采用CO2联合造影剂造影是安全有效的,并且可降低术后胆管炎发生率。

Objective To evaluate radiography with C02 combined with contrast agents for endoscopic drainage of unresectable hilar cholangiocarcinoma. Methods Clinical data of 43 patients with unresectable hilar cholangiocarcinoma undergoing endoscopic drainage at the First Hospital of Lanzhou University from October 2010 to October 2015 were analyzed retrospectively. According to different contrast agents in radiography, patients were divided into the study group ( C02 combined with contrast agent) and the control group ( contrast agent alone). There were 23 cases in the study group and 20 cases in the control group. Total postoperative bilirubin (TBIL), white blood cell ( WBC), procalcitonin ( PCT) and the incidence of complications in the two groups were compared. Results The endoscopic procedure ranged from 50 min to 70 min. TBIL, WBC, PCT at 48 h and 72 h after operation in the study group were lower than those in the control group[48 h TBIL:(173. 42±66. 78)μmol/L VS (210. 81±78. 34)μmol/L,P=0. 025;72 h TBIL:(104. 64±56. 35)μmol/L VS (159. 33±59. 59)μmol/L, P=0.023;48 h WBC:(11. 5l±7. 78) x 10^9/L VS (15. 83± 6.67)x10^9/L, P = 0.026;72 h WBC:(10. 92±5. 64) x 10^9/L VS (14. 72±4. 97)x10^9/L, P=0. 026;48 h PCT:(0. 56±0. 18) ng/mL VS ( 1. 24±0. 73) ng/mL, P = 0. 003;72 h PCT:(0. 42± 0. 27) ng/mL VS (0. 90±0. 20) ng/mL, P = 0. 001 ]. The incidence of postoperative cholangitis in the study group was lower than that in the control group [13. 0%(3/23) VS 40%(8/20), P=0. 043]. Relatively low incidence of postoperative pancreatitis occurred in both groups, with no significant difference [4. 3%( 1/23) VS 10. 0%(2/20), P = 0. 090 ]. Conclusion Radiography with CO2 combined with contrast agents during endoscopic drainage procedures for unresectable hilar cholangiocarcinoma is safe and effective, which could lower incidence of postoperative cholangitis.