PTCD与ERCP对急性梗阻化脓性胆管炎老年患者炎症反应的对比研究

Efficacy of PTCD and ERCP for treatment of acute obstructive suppurative cholangitis in elderly patients

目的对比经皮经肝胆管引流术(percutaneous transhepatic biliary drainage,PTCD)与经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)对急性梗阻化脓性胆管炎老年患者炎症反应的作用。方法选取2017年1月—2018年12月就诊的急性梗阻化脓性胆管炎老年患者74例,根据治疗方式分为PTCD组和ERCP组。比较两组患者手术前后白细胞计数、C反应蛋白、降钙素原、血乳酸等炎症指标以及炎症因子水平和肝脏生化指标,分析两组患者术后症状缓解时间、住院时间、临床疗效和短期并发症发生情况。结果两组患者手术前炎症指标以及IL-1、IL-2、IL-6与TNF-α等炎症因子水平差异无统计学意义(P>0.05),术后3 d两组上述指标均较前显著下降(P<0.05),且ERCP组显著低于PTCD组(P<0.05);两组总胆红素、直接胆红素、间接胆红素、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)及丙氨酸氨基转移酶水平于手术前差异均无统计学意义(P>0.05),术后3 d均较前显著下降(P<0.05),且ERCP组也均显著低于PTCD组(P<0.05)。两组患者术后发热缓解时间和寒战消失时间差异无统计学意义(P>0.05),ERCP组腹痛缓解时间显著短于PTCD组(P<0.05),ERCP组平均住院时间显著短于PTCD组(P<0.05)。ERCP组与PTCD组的临床疗效、治疗总有效率和不良反应发生情况差异均无统计学意义(P>0.05)。结论PTCD与ERCP均能有效治疗急性梗阻化脓性胆管炎,但是ERCP在改善炎症反应和肝功能以及减轻肝脏损伤方面更具优势,且能够更快地缓解腹痛症状并减少住院天数。

Objective To investigate the efficacy of percutaneous transhepatic biliary drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)for treatment of acute obstructive suppurative cholangitis in elderly patients.Methods Seventy-four patients aged above 60 years with acute obstructive suppurative cholangitis treated with PTCD or ERCP from Jan 2017 to Dec 2018 were included in the analysis.The clinical efficacy,time of symptom relief,length of hospital stay and short-term complications were documented.The infection indexes(WBC,CRP,PCT,LAC),the level of inflammatory factors(IL-1,IL-2,IL-6,TNF-α)and the liver function were then compared between the two groups.Results There were no significant differences in the levels of WBC,CRP,PCT,LAC and IL-1,IL-2,IL-6,TNF-α between the two groups before operation(P>0.05);the above indexes significantly decreased in the two groups 3 days after operation(P<0.05),and those in ERCP group were significantly lower than those in PTCD group(P<0.05).There were no significant differences in the levels of TBIL,DBIL,IBIL,AST and ALT before operation between the two groups(P>0.05),the above indexes significantly decreased in the two groups 3 days after operation(P<0.05),while those in ERCP group were significantly lower than those in PTCD group(P<0.05).There was no significant difference between the two groups in the time of fever relief and the time of shivering disappearance(P>0.05),while the time of abdominal pain relief in ERCP group was significantly shorter than that in PTCD group(P<0.05),and the average hospitalization time of ERCP group was significantly shorter than that of PTCD group(P<0.05).There were no significant differences in clinical efficacy,total effective rate and adverse reactions between ERCP group and PTCD group(P>0.05).Conclusion Both PTCD and ERCP can effectively treat acute obstructive suppurative cholangitis,but ERCP has advantages in improving inflammatory response and liver function,relieving abdominal pain and reducing length of hospital stay.