超声引导下经皮经肝胆囊穿刺引流术在急性胆源性胰腺炎治疗中的应用

Application value of percutaneous transhepatic gallbladder drainage guided by ultrasound in the treatment of acute biliary pancreatitis

目的:探讨超声引导下经皮经肝胆囊穿刺引流术(PTGD)对于急性胆源性胰腺炎的治疗价值。方法:选择急性胆源性胰腺炎病人128例,按是否行PTGD分为观察组(64例,行PTGD引流术)和对照组(64例,不行胆囊穿刺),2组均给予相同的常规治疗。比较2组病人治疗后指标[腹胀缓解时间、排气时间、住院时间、白细胞(WBC)、谷氨酸氨基转移酶(ALT)、总胆红素、降钙素原(PLT)、乳酸、Bahhazar CT评分]、并发症情况包括胰周积液、胰周感染、胰瘘、急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)及病死率情况。结果:与对照组比较,观察组病人腹胀缓解时间、排气时间、胰周积液率、胰周感染率、住院时间均较低,差异有统计学意义(P<0.05~P<0.01);2组病人胰瘘率、ARDS率、MODS率和病死率差异无统计学意义(P>0.05);实验室检查,2组病人入院时WBC、ALT、胆红素、PCT、乳酸和Balthazar CT评分差异无统计学意义(P>0.05),入院3 d和6 d时WBC、ALT、胆红素、PCT和乳酸值观察组均低于对照组,入院7 d时Balthazar CT评分值观察组低于对照组,差异均有统计学意义(P<0.05~P<0.01)。结论:PTGD效果好、安全性高,可明显改善急性胆源性胰腺炎治疗效果。

Objective:To explore the therapeutic value of percutaneous transhepatic gallbladder drainage(PTDG)guided by ultrasound in acute biliary pancreatitis.Methods:A total of 128 patients with acute biliary pancreatitis were divided into the observation group(64 cases treatment with PTGD)and control group(64 cases treatment without PTGD),and two groups were treated with the same routine method.After treatment,the indicators(including the abdominal distension relief time,exhaust time,hospital stay,white cells count,glutamic amino transferase,total bilirubin,procalcitonin,lactic acid and Bahhazar CT score),and complications(including peripancreatic effusion,peripancreatic infection,pancreatic fistula,ARDS,MODS incidence of effusion,peripancreatic infection,pancreatic fistula and mortality)were compared between two groups.Results:Compared with the control group,the diarrhea remission time,exhaust time,peripancreatic effusion rate,peripancreatic infection rate and hospital stay in the observation group were low,and the differences of whose between two groups were statistically significant(P<0.05 to P<0.01).The differences of the pancreatic fistula rate,ARDS rate,MODS rate and mortality between two groups were not statistically significant(P>0.05).The differences of the WBC,ALT,bilirubin,PCT,lactic acid and Balthazar CT score between two groups on admission were not statistically significant(P>0.05),the levels of WBC,ALT,bilirubin,PCT and lactic acid in observation group were lower than those in control group after 3 d and 6 d of admission,and the Balthazar CT score was lower than that in observation group after 7 d of admission(P<0.05 to P<0.01).Conclusions:PTGD is effective and safe,and can significantly improve the therapeutic effect of acute biliary pancreatitis.