内镜介入治疗急性梗阻化脓性胆管炎的临床研究  

Clinical effect of endoscopy on acute obstructive suppurative cholangitis and its influence on the inflammatory cytokines and liver function

作　　者：赵昕波 游红勇[1] 李兵[1] 陈智敏[1] 刘东涛[1] 

机构地区：[1]四川省崇州市人民医院胃肠外科,四川崇州611230

出　　处：《中国医药导报》2015年第11期129-132,共4页China Medical Herald

摘　　要：目的探讨内镜逆行胰胆管造影（ERCP）配合内镜鼻胆管引流术（ENBD）治疗急性梗阻化脓性胆管炎（AOSC）的临床效果及其对炎症因子和肝脏功能的影响。方法选取2006年1月-2013年11月四川省崇州市人民医院诊治的78例老年AOSC患者为研究对象,根据手术方式的不同分为观察组（41例）和对照组（37例）。观察组给予急诊ERCP配合ENBD术治疗,对照组给予外科传统手术治疗。比较两组患者的临床疗效及其对炎症因子和肝脏功能的影响。结果术后观察组患者的治愈率为58.54%,明显高于对照组的35.14%,且观察组患者腹痛缓解时间、黄疸减轻时间、胃肠功能恢复时间、引流管拔除时间和总住院时间均明显短于对照组,差异均有统计学意义（P〈0.05或P〈0.01）;但两组患者术后合并症发生率比较,差异无统计学意义（P〉0.05）。术前两组患者丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、血清胆红素（TBIL）、白蛋白（ALB）、前白蛋白（PALB）、胆碱酯酶（ChE）、炎症因子和超敏C反应蛋白（hs-CRP）的水平比较,差异无统计学意义（P〉0.05）;术后两组患者的ALT、AST、GGT、TBIL、白细胞介素-4（IL-4）、IL-6、IL-8、肿瘤坏死因子-α和hsCRP明显降低（P〈0.05）,而ALB、PALB、ChE和IL-10则显著升高（P〈0.05）。观察组炎性指标的改善程度明显优于对照组（P〈0.05）,但肝功能指标两组间比较,差异无统计学意义（P〉0.05）。结论内镜介入治疗老年AOSC患者的总体疗效优于传统手术,且能够减轻机体炎性反应。Objective To explore the clinical effect of endoscopic retrograde cholangiopancreatography（ERCP）-endoscopic nasobiliary drainage（ENBD） on acute obstructive suppurative cholangitis（AOSC） and influence on the inflammatory cytokines, bile secretion and liver function. Methods 78 cases of elderly patients with AOSC from January 2006 to November 2013 in the People＇s Hospital of Chongzhou City were recruited in this study, and divided into observation group（41 cases） and control group（37 cases）. Patients of the observation group were given ERCP combined with ENBD therapy, and the control group was given the traditional surgical operation. Clinical curative effects and the inflammatory cytokines, bile secretion and liver function of two groups were compared. Results After operation, cure rate of the observation group was 58.54%, showed significantly higher than that of the control group of 35.14%; moreover, abdominal pain relief time, jaundice, gastrointestinal function recovery time, drainage tube release time and total hospital stay time of the observation group were significantly shorter than those of the control group（P〈0.05 or P〈0.01）; complication of two groups showed no significant difference（P〉0.05）; liver function biochemical indexes of ALT, AST, GGT,TBIL, ALB, PALB, ChE, inflammatory factors and hs-CRP showed no significant difference between two groups before treatment（P〉0.05）; after operation, the levels of ALT, AST, GGT, TBIL, IL-4, IL-6, IL-8, TNF-α, and hs-CRP of two groups were obviously decreased（P〈0.05）, while ALB, PALB, ChE and IL-10 were significantly increased（P〈0.05）; importantly, the degree of improvement of inflammatory factors in the observation group were significantly better than those of the control group（P〈0.05）, no significant difference was observed in liver function indicators（P〉0.05）.Conclusion The clinical effect of endoscopy is better than the traditional operation on the elderly patients with AOSC and can alleviate inf

关 键 词：急性梗阻化脓性胆管炎 内镜 炎症因子 肝脏功能 

分 类 号：R657.4[医药卫生—外科学]