内镜逆行胰胆管造影治疗肝硬化并发急性梗阻性化脓性胆管炎的临床疗效  

Clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of liver cirrhosis complicated with acute obstructive suppurative cholangitis

作　　者：覃冬林[1] 欧琴[1] 覃馨颉 QIN Dong-lin;OU Qin;QIN Xin-jie(Department of Gastroenterology,People’s Hospital of Hechi,Hechi 547000,China)

机构地区：[1]广西壮族自治区河池市人民医院消化内科,547000

出　　处：《临床合理用药杂志》2020年第33期7-10,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的内镜逆行胰胆管造影(ERCP)治疗肝硬化并发急性梗阻性化脓性胆管炎(AOSC)的临床疗效。方法选取河池市人民医院肝胆外科2015年2月—2018年2月收治的因AOSC而需要接受ERCP手术治疗的患者180例,按照是否合并肝脏病变分为正常组、肝炎组、肝硬化组,各60例。所有患者接受ERCP治疗后,比较3组ERCP成功率,比较3组手术前后生化指标、白细胞(WBC)、中性粒细胞百分比、淀粉酶,并比较3组并发症发生情况。结果 3组ERCP成功率比较,差异无统计学意义(P>0.05)。肝硬化组血清白蛋白(ALB)水平低于正常组、肝炎组,手术前后肝硬化组丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)水平低于正常组、肝炎组,手术前后肝硬化组血清总胆红素(TBiL)水平高于正常组、肝炎组(P<0.05)。3组手术前后WBC、中性粒细胞百分比、淀粉酶比较,差异无统计学意义(P>0.05)。肝硬化组并发症发生率高于肝炎组、正常组(P<0.05)。肝硬化组高淀粉酶血症发生率高于肝炎组、正常组(P<0.05)。肝硬化组患者A级并发症发生率低于B级、C级(P<0.05)。结论 ERCP治疗肝硬化并发AOSC的临床疗效确切,可以有效地治疗肝硬化患者AOSC症状,安全性高、成功比例也较高,同时需要严密观察高淀粉酶血症的发生。Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography(ERCP) in the treatment of liver cirrhosis complicated with acute obstructive suppurative cholangitis(AOSC).Methods A total of 180 cases of patients with AOSC who needed ERCP were selected from February 2015 to February 2018 in the Department of Hepatobiliary Surgery of People's Hospital of Hechi,which were randomly divided into normal group,hepatitis group and liver cirrhosis group according to whether or not they were combined with liver diseases,60 cases in each group.After ERCP treatment,the success rate of ERCP,biochemical indexes,white blood cell(WBC),neutrophil percentage,amylase,and complications of the three groups were compared.Results There was no significant difference in the success rate of ERCP among the three groups(P>0.05).The level of serum albumin(ALB)in cirrhosis group was lower than that in normal group and hepatitis group.The levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)before and after operation in cirrhosis group were lower than those in normal group and hepatitis group.Serum total bilirubin(TBiL)level in cirrhosis group before and after operation was higher than that in normal group and hepatitis group(P<0.05).There was no significant difference in WBC,neutrophil percentage and amylase among the three groups before and after operation(P>0.05).The incidence of complications in liver cirrhosis group was higher than that in hepatitis group and normal group(P<0.05).The incidence of hyperamylasemia in liver cirrhosis group was higher than that in hepatitis group and normal group(P<0.05).The incidence of A-level complications in patients with liver cirrhosis was lower than that in patients with grade B and grade C(P<0.05).Conclusion ERCP can effectively treat the symptoms of AOSC in patients with liver cirrhosis,with high safety and high success rate.At the same time,the occurrence of hyperamylasemia should be closely observed.

关 键 词：肝硬化 内镜逆行胰胆管造影 急性梗阻性化脓性胆管炎 临床疗效 

分 类 号：R657.45[医药卫生—外科学] R657.31[医药卫生—临床医学]