ERCP内引流与传统外引流在先天性胆管扩张症伴严重胆管炎患儿中的对比研究

Endoscopic retrograde cholangiopancreatography drainage versus traditional external drainage for children with serious cholangitis caused by congenital biliary dilatation

目的比较内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)内引流与传统外引流手术在先天性胆管扩张症伴严重胆管炎患儿中的疗效差异。方法回顾性分析2015年1月至2019年12月南京医科大学附属儿童医院普外科收治的57例先天性胆管扩张症伴有严重胆管炎患儿的临床资料。其中,男14例,女43例;年龄6~135个月。按引流方式不同,将患儿分为外引流组32例和ERCP组25例。外引流组引流方式包括胆道T管引流、经皮囊肿穿刺引流和胆囊引流。ERCP组采用ERCP引导下置入胆道支架引流。应用t检验、卡方检验,对两组的手术时间、术后住院时间、FLACC评分、术后每公斤体重补液量及术后相关并发症发生情况进行对比分析。结果外引流组的手术时间和术后住院时间分别为(59.84±34.35)min和(11.53±4.98)d,ERCP组的手术时间和术后住院时间分别为(11.40±2.12)min和(5.72±2.60)d,组间比较,差异均有统计学意义(P均<0.001)。外引流组术后24 h和48 h的FLACC评分分别为(3.34±1.07)分和(0.84±0.85)分,ERCP组术后24 h和48 h的FLACC评分分别为(0.76±0.67)分和(0.24±0.44)分,组间比较,差异均有统计学意义(P均≤0.001)。ERCP组术后第1、3、5、7天每公斤体重补液量分别为(70.30±17.04)ml/kg、(29.24±20.99)ml/kg、(13.35±20.76)ml/kg、(5.60±14.62)ml/kg,较外引流组的(93.25±20.21)ml/kg、(70.67±37.91)ml/kg、(45.20±30.95)ml/kg、(32.44±27.46)ml/kg少,且组间比较,差异均有统计学意义(P均<0.05)。外引流组术后出现切口感染8例(25.00%)、肠粘连8例(25.00%),ERCP组未出现切口感染和肠粘连的患儿,组间比较,差异均有统计学意义(P均=0.007)。结论与传统的外引流手术相比,先天性胆管扩张症伴严重胆管炎患儿ERCP引流安全、有效,且创伤小,恢复快。

Objective To compare the difference and safety of bile duct drainage guided by endoscopic retrograde cholangiopancreatography(ERCP)versus traditional external drainage for children with severe cholangitis caused by congenital biliary dilatation(CBD).Methods A retrospective analysis was performed for clinical data of 57 CBD children admitted with severe cholangitis from January 2015 to December 2019.There were 14 boys and 43 girls with an age range of 6-135 months.According to different drainage methods,they were divided into two groups of external drainage(n=32)and ERCP drainage(n=25).T-tube external drainage through cyst,puncture external drainage through cyst and drainage of gallbladder were designated as external drainage group.Bile duct drains with stent insertion guided by ERCP were designated as ERCP group.Using t-test,analysis of variance,operative duration,postoperative hospital stay,FLACC score,postoperative fluid supplement per kilogram of body weight and postoperative complications were compared between two groups.Results As compared with ERCP group,operative duration(59.84±34.35 vs.11.40±2.12 min;P<0.001)and postoperative hospital stay(11.53±4.98 vs.5.72±2.60 days;P<0.001)were significantly longer and FLACC score(24h:3.34±1.07 vs.0.76±0.67;P<0.001 and 48h:0.84±0.85 vs.0.24±0.44;P=0.001)was greater in external drainage group.At Day 1/3/5/7 post-operation,amount of fluid supplement per kilogram of body weight was(70.30±17.04),(29.24±20.99),(13.35±20.76),(5.60±14.62)ml/kg in ERCP group.They were less than those of external drainage group(93.25±20.21),(70.67±37.91),(45.20±30.95)and(32.44±27.46)ml/kg.The inter-group differences were statistically significant(P<0.05).Incision infection rate and intestinal adhesion rate were 25.00%(8/32)and 25.00%(8/32)in external drainage group.In ERCP group,there was no instance of incisional infection or intestinal adhesions.The inter-group differences were statistically significant(P=0.007).Conclusions As compared with traditional external drainage,ERCP drainage is mini-invasive,safe and effective for children with severe cholangitis due to CBD.