超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析

Efficacy of ultrasound-guided percutaneous transhepatic cholangiography in the treatment of patients with acute obstructive suppurative cholangitis

目的探讨在超声引导下经皮经肝胆管穿刺引流术(PTCD)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法2015年3月~2018年11月我院肝胆外科收治的78例AOSC患者,被随机分为开腹组(n=39)和PTCD(n=39),分别采取开腹手术和在超声引导下PTCD治疗。结果PTCD组手术时间、出血量、留置引流管时间和住院时间分别为(89.7±7.5)min、(26.3±2.4)ml、(8.8±1.0)d和(9.7±1.5)d,均显著少于或短于开腹组【分别为(120.8±10.6)min、(40.4±4.3)ml、(13.2±2.9)d和(18.6±3.8)d,P<0.05】;治疗后,两组患者肝功能指标变化无统计学差异(P>0.05);PTCD治疗患者血清降钙素原、白介素-6、白介素-4和C反应蛋白水平分别为(5.9±0.8)ng/L、(87.8±7.4)ng/L、(14.7±1.5)ng/L和(2.1±0.5)mg/L,均显著低于开腹组【分别为(8.9±1.2)ng/L、(102.9±11.3)ng/L、(22.4±2.1)ng/L和(3.1±0.7)mg/L,P<0.05】;PTCD治疗组术后并发症发生率显著低于开腹组(5.1%对23.1%,P<0.05)。结论超声引导下PTCD治疗AOSC患者可有效改善手术相关指标,减少并发症的发生,可能与引起机体炎症反应较轻有关。

Objective The aim of this study was to investigate the efficacy of ultrasound-guided percutaneous transhepatic cholangiography(PTCD)in the treatment of patients with acute obstructive suppurative cholangitis((AOSC).Methods 78 patients with AOSC were recruited in our hospital between March 2015 and November 2018,and were randomly divided into control(n=39)and observation group(n=39).The patients in the control group were treated with conventional laparotomy,and those in the observation group were treated with ultrasound-guided PTCD.Results The operative time,the amount of bleeding,the time of indwelling drainage tube and the hospital stay in PTCD-treated patients were(89.7±7.5)min,(26.3±2.4)ml,(8.8±1.0)d and(9.7±1.5)d,significantly less or shorter than[(120.8±10.6)min,(40.4±4.3)ml,(13.2±2.9)d and(18.6±3.8)d,P<0.05]in the control;After treatment,serum levels of procalcitonin,interleukin-6,interleukin-4 and C-reactive protein in the observation group were(5.9±0.8)ng/L,(87.8±7.4)ng/L,(14.7±1.5)ng/L and(2.1±0.5)mg/L,significantly lower than[(8.9±1.2)ng/L,(102.9±11.3)ng/L,(22.4±2.1)ng/L and(3.1±0.7)mg/L,respectively,P<0.05]in the control;the complication rate in the observation group was significantly lower than that in the control group(5.1%vs.23.1%,P<0.05).Conclusion Ultrasound guided PTCD treatment of patients with AOSC is efficacious,which effectively improve the surgery-related indexes and reduce complications,which might be related to mild inflammatory reaction.