急诊介入引流治疗急性重症胆道感染的临床疗效分析

Clinical analysis of emergency interventional drainage in the treatment of acute severe biliary tract infection

目的探讨急诊行介入引流治疗急性重症胆道感染的临床疗效。方法回顾性分析本院2014年6月至2019年8月因急性重症胆道感染急诊行经皮肝穿刺胆道引流(PTCD)及经皮胆囊穿刺置管引流(PTGD)的29例患者的临床资料,通过手术前后症状体征、感染指标、细菌培养、胆红素的变化情况,总结介入临床疗效及治疗经验。结果介入引流手术成功率96.55%,并发胆道出血1例,围术期死亡2例。26例患者术后3~5 d症状体征明显减轻,胆汁引流正常,感染指标明显好转,胆红素下降。后续外科手术13例,其中3例因复发行两次手术治疗。未进行手术14例,4例胆囊造瘘患者4~6周后复查造影胆囊管通畅而拔除引流管,5例在随访中病情进展死亡,5例继续带管(其中2例为肿瘤患者拒绝手术,1例结石患者拒绝手术,2例结石患者拟择期行外科手术)。结论介入引流能迅速解除胆道梗阻,降低胆道压力,缓解临床症状,降低病死率,并为后续二期再处理创造条件和机会,并发症及围术期死亡率较低,安全有效。

Objective To investigate the clinical effect of interventional drainage in the treatment of the acute severe biliary tract infection.Methods The clinical data of 29 patients with acute severe biliary tract infection in our hospital from June 2014 to August 2019 were retrospectively analyzed.Through the changes of symptoms and signs,infection index,bacterial culture and bilirubin before and after operation,the clinical effect and treatment experience of interventional therapy were summarized.Results The success rate of interventional drainage was 96.55%.1 case was complicated with biliary hemorrhage,and 2 cases died in perioperative period.The symptoms and signs of 26 patients were obviously relieved 3-5 d after operation,bile drainage was normal,infection index was obviously improved,bilirubin was decreased.Follow up surgery was performed in 13 cases,of which 3 cases were treated twice due to reoperation.14 cases were not operated on,4 cases underwent cholecystostomy,4-6 weeks later,the cystic duct was unobstructed and the drainage tube was removed,5 cases died in the follow-up,5 cases continued to take the tube(2 cases were tumor rejection,1 case was stone rejection,2 cases were stone selection for surgery).Conclusion Interventional drainage can quickly relieve biliary obstruction,reduce pressure of biliary tract,relieve clinical symptoms,reduce mortality,and create conditions and opportunities for follow-up secondary treatment.Complications and perioperative mortality are low,it is safe and effective.