胆源性肝损伤临床特征分析及治疗手段探讨

Clinical features and management of patients with biliary liver injury

目的分析总结胆源性肝损伤(BLI)患者的临床特征,探讨磁共振胰胆管造影(MRCP)阴性的BLI患者内镜下逆行胰胆管造影术(ERCP)治疗和预后。方法2018年1月~2019年12月我院收治的BLI患者77例,其中MRCP检查为阴性组34例和MRCP阳性组43例。根据病情,给予内镜乳头括约肌切开术(EST)或狭窄处扩张术治疗。结果在77例患者中,有黄疸者70例(92.2%),腹痛者65例(84.4%),发热者27例(35.1%);腹部超声检查提示胆囊结石48例(62.3%),胆囊切除术后14例(18.2%);ERCP术后诊断为胆总管结石者71例(92.2%),MRCP阴性组胆总管泥沙样结石占91.2%,显著高于MRCP阳性组的9.3%,两组性别、年龄以及腹痛、黄疸发生率比较无显著性差异(P>0.05);MRCP阴性组患者发热发生率为20.6%,显著低于MRCP阳性组的46.5%(P<0.05),MRCP阴性组患者中性粒细胞百分数为(66.6±14.4)%,显著低于MRCP阳性组【(74.6±14.8)%,P<0.05】;两组血清谷丙转氨酶(ALT)、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)和总胆红素(TBIL)水平无显著性差异(P>0.01);MRCP阴性组与阳性组ERCP术成功率和术后并发症发生率比较无显著性差异(P>0.05)。结论胆总管泥沙样结石是MRCP阴性的BLI患者最常见的病因。对于MRCP阴性的BLI患者,如伴有发热或/和中性粒细胞百分数升高,应高度怀疑BLI的可能,而给予相应的处理。

Objective The aim of this study was to summarize the clinical features of patients with biliary liver injury(BLI)and observe the magnetic resonance cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)results.Methods 77 patients with BLI were recruited in our hospital between January 2018 and December 2019,and all underwent MRCP and ERCP,and endoscopic sphincterotomy(EST)when necessary.Result Among the 77 patients,the clinical symptoms and sign included jaundice in 70 cases(90.9%),abdominal pain in 65 cases(84.4%),and fever in 27 cases(35.1%),and the MRCP found negative in 34 and positive in 43 cases;the ultrasound examination showed cholelithiasis in 48 cases(62.3%),and cholecystectomy history in 14 cases(18.2%);71 cases(92.2%)were diagnosed as choledocholithiasis by ERCP,and the percentage of mud-like stones in common bile duct in MRCP negative group was 91.2%,significantly higher than 9.3%in MRCP positive group;there was no significant differences respect to age,gender,incidence of abdominal pain and jaundice between the two groups(P>0.05);the incidence of fever in the MRCP negative group was 20.6%,significantly lower than 46.5%in MRCP positive group(P<0.05);the percentage of neutrophils in MRCP negative group was(66.6±14.4)%,significantly lower than(74.6±14.8)%in MRCP positive group(P<0.05);there were no significant differences respect to blood biochemical parameters between the two groups(P>0.05);the success rates and the complication rates of ERCP in the two groups were not significantly different(P>0.05).Conclusion The mud-like stones in common bile duct are the most common cause of BLI in MRCP negative patients,and the ERCP is a safe and effective treatment for the patients with BLI when the MRCP examination is negative.