内镜下鼻胆管引流术与经皮肝穿刺胆道引流术治疗急性梗阻性化脓性胆管炎的效果对比

Comparison of the Effect of Endoscopic Nosal Biliary Drainage and Percuteneous Transhepatic Cholangio Drainage in the Treatment of Acute Obstructive Suppurative Cholangitis

目的:探究内镜下鼻胆管引流术(ENBD)与经皮肝穿刺胆道引流术(PTCD)治疗急性梗阻性化脓性胆管炎(AOSC)的效果。方法:回顾性分析2021年1月—2023年12月在九江市第一人民医院治疗的94例AOSC患者的病历资料,按照手术方式不同分为两组,各47例;对照组接受ENBD治疗,观察组接受PTCD治疗。观察两组临床疗效、炎症反应、肝脏生化指标及并发症发生率。结果:两组治疗总有效率比较,差异无统计学意义(P>0.05)。治疗前,两组白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、降钙素原(PCT)、血乳酸(Lac)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平比较,差异均无统计学意义(P>0.05);治疗后,两组WBC、CRP、TNF-α、IL-1、IL-2、IL-6、PCT、Lac、TBIL、DBIL、IBIL、AST、ALT均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:ENBD与PTCD治疗AOSC效果相当,但PTCD可减轻炎症反应及肝功能损伤,降低并发症发生率。

Objective:To explore the efficacy of endoscopic nosal biliary drainage(ENBD)and percuteneous transhepatic cholangio drainage(PTCD)in the treatment of acute obstructive suppurative cholangitis(AOSC).Method:The medical records of 94 patients with AOSC treated in Jiujiang NO.1 People's Hospital from January 2021 to December 2023 were retrospectively analyzed,and they were divided into two groups according to different surgical methods,with 47 cases in each group.The control group received ENBD treatment,and the observation group received PTCD treatment.The clinical efficacy,inflammatory response,liver biochemical indexes and complication rate of the two groups were observed.Result:There was no significant difference in the total effective rate between the two groups(P>0.05).Before treatment,there were no significant differences in white blood cells(WBC),C reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-2(IL-2),interleukin-6(IL-6),procalcitonin(PCT),blood lactic acid(Lac),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels between the two groups(P>0.05).After treatment,WBC,CRP,TNF-α,IL-1,IL-2,IL-6,PCT,Lac,TBIL,DBIL,IBIL,AST and ALT in both groups were lower than those before treatment,and those in observation group were lower than those in control group,the differences were statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:The effect of ENBD is similar to PTCD in the treatment of AOSC,but PTCD can reduce inflammation and liver function injury,and reduce the incidence of complications.