超声引导下经皮肝胆道穿刺置管引流在急性胆道感染治疗中的应用

Application of ultrasound-guided percutaneous transhepaticcholangial drainage in the treatment of acute infection of biliary tract

目的探讨急性胆道感染采用超声引导下经皮肝胆道穿刺置管引流治疗的效果。方法对2019年1月至2020年1月在江西省赣州市人民医院接受治疗的59例急性胆道感染患者进行研究,根据治疗方案的不同分为A组20例,采用常规内科治疗;B组39例,采用超声引导下经皮肝胆道(胆囊或肝内胆管)穿刺置管引流,以临床总有效率、住院时间、治疗前后白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)变化情况及肝穿刺窦道出血、胆汁性腹膜炎、胆管血管瘘、血清炎症因子水平、并发症发生情况完成对临床疗效的评估。结果B组临床总有效率为94.87%,高于A组的60.00%,差异有统计学意义(P<0.05);B组住院时间短于A组,差异有统计学意义(P<0.05);治疗后,两组血清IL-6、hs-CRP、TNF-α水平均较治疗前有所下降,但B组上述指标明显低于A组,差异有统计学意义(P<0.05);B组并发症总发生率为5.13%,低于A组的20.00%,差异有统计学意义(P<0.05)。结论对急性胆道感染患者实施超声引导下经皮肝胆道穿刺置管引流具有较好的治疗效果,可有效提高临床疗效,有效减轻机体炎症反应,减少并发症,促进患者康复,具有创伤小、操作简便、安全性高等特点。

Objective To investigate the effect of ultrasound-guided percutaneous transhepaticcholangial drainage(PTCD)on acute infection of biliary tract.Methods A total of 59 patients with acute infection of biliary tract who received treatment in our hospital from January 2019 to January 2020 were studied.According to different treatment schemes,they were divided into group A(n=20)and group B(n=39).Group A was received conventional medical treatment.Group B was received ultrasound-guided PTCD(gallbladder or intrahepatic bile duct).The total clinical efficacy,the time of hospitalization,the changes of interleukin-6(IL-6),high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)before and after the treatment,hepatic puncture sinus hemorrhage,biliary peritonitis and biliary vascular fistula were used to evaluate the clinical efficacy,the level of serum inflammatory factors and the occurrence of complications.Results The total clinical effective rate was 94.87%in group B,which was higher than that of 60.00%in group A,with statistically significant difference(P<0.05).The hospitalization time was shorter in group B than that in group A,with statistically significant difference(P<0.05).After treatment,the levels of serum IL-6,hs-CRP and TNF-αin the two groups decreased,but the above indexes in group B were lower than those in group A,with statistically significant difference(P<0.05).The incidence of complications was 5.13%in group B,which was lower than that of 20.00%in group A,with statistically significant difference(P<0.05).Conclusion Ultrasound-guided PTCD has a good therapeutic effect for patients with acute infection of biliary tract,which can effectively improve clinical efficacy,effectively reduce body inflammatory reaction,reduce complications,promote patients’rehabilitation,and has the characteristics of less trauma,simple operation,high safety,etc.