经皮经肝胆囊穿刺引流在急性胰腺炎合并胆囊炎或胆道梗阻的临床应用价值  

Clinical value of percutaneous transhepatic gallbladder drainage for acute pancreatitis complicated with cholecystitis or biliary obstruction

作　　者：张正乐 赵传兵 李汉军 熊星铖[1] 张瑶 陶京 Zhang Zhengle;Zhao Chuanbing;Li Hanjun;Xiong Xingcheng;Zhang Yao;Tao Jing(Department of Pancreatic Surgery,Renmin Hospital,Wuhan University,Hubei Wuhan 430060,China;Department of Ultrasonography,Renmin Hospital,Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胰腺外科,湖北武汉430060 [2]武汉大学人民医院超声科,湖北武汉430060

出　　处：《腹部外科》2023年第1期45-49,共5页Journal of Abdominal Surgery

基　　金：湖北省卫生厅科研一般项目(WJ2021M253)。

摘　　要：目的探索经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)在急性胰腺炎合并胆囊炎或胆道梗阻病人的应用效果及价值。方法回顾性分析于武汉大学人民医院行PTGD治疗的34例急性胰腺炎合并胆囊炎或胆道梗阻病人的临床资料,统计分析其穿刺前后炎症指标、危重症评分、肝功能指标改变以及穿刺成功率、并发症发生率等结局。结果34例病人,轻症急性胰腺炎9例,中重症急性胰腺炎25例,穿刺成功率为100%。病人穿刺前与穿刺后1周以下指标比较,差异均有统计学意义:白细胞计数[(15.58±7.62)×10^(9)/L比(11.06±6.45)×10^(9)/L,P=0.006],中性粒细胞计数[(13.76±7.34)×10^(9)/L比(9.11±6.15)×10^(9)/L,P=0.003],降钙素原[M(P25,P75),1.10(0.42,3.19)μg/L比0.39(0.17,1.12)μg/L,P<0.001],C-反应蛋白[(154.35±86.15)mg/L比(78.51±61.30)mg/L,P<0.001],全身炎症反应综合征(SIRS)评分[(2.68±1.15)分比(1.26±1.11)分,P<0.001],序贯器官衰竭评估(SOFA)评分[(5.59±3.20)分比(3.56±2.78)分,P<0.001],急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分[(10.79±3.08)分比(7.74±3.01)分,P<0.001]。其中,22例合并梗阻性黄疸的病人穿刺前后以下指标差异均有统计学意义:总胆红素[(123.93±92.89)μmol/L比(70.70±61.55)μmol/L,P=0.005],直接胆红素[(93.00±70.22)μmol/L比(54.50±49.08)μmol/L,P=0.005],谷丙转氨酶[(108.09±87.18)U/L比(28.73±13.59)U/L,P<0.001],谷草转氨酶[(134.00±123.81)U/L比(34.36±14.16)U/L,P=0.001]。有2例(5.88%)穿刺后发生脱管,无出血及胆瘘;2例(5.88%)病人最终死亡,死亡原因为后期胰腺坏死合并复杂腹腔感染导致多器官功能衰竭。结论PTGD作为过渡手段,技术操作简单,安全有效,对于急性胰腺炎合并胆囊炎或胆道梗阻的病人有一定临床治疗价值。Objective To explore the efficacies and values of percutaneous transhepatic gallbladder drainage(PTGD)for patients with acute pancreatitis(AP)complicated with cholecystitisor biliary obstruction.Methods A total of 34 AP patients complicated with cholecystitis or biliary obstruction undergoing PTGD were retrospectively reviewed.The changes in inflammatory parameters,critical disease scores,liver function parameters,success rate and incidence of complication after drainage were statistically compared.Results There were mild AP(n=9)and moderate-severe AP(n=25).As compared with pre-drainage,there were significant differences after drainage,including leucocyte count[(15.58±7.62)×10^(9)/L vs.(11.06±6.45)×10^(9)/L,P=0.006],neutrophil cell count[(13.76±7.34)×10^(9)/L vs.(9.11±6.15)×10^(9)/L,P=0.003],procalcitonin[M(P25,P75),1.10(0.42,3.19)μg/L vs.0.39(0.17,1.12)μg/L,P<0.001],C-reactive protein[(154.35±86.15)vs.(78.51±61.30)mg/L,P<0.001],SIRS score[(2.68±1.15)vs.(1.26±1.11),P<0.001],SOFA score[(5.59±3.20)vs.(3.56±2.78),P<0.001]and APACHEⅡscore[(10.79±3.08)vs.(7.74±3.01),P<0.001].And 22 cases were accompanied with obstructive jaundice before drainage.After PTGD,total bilirubin[(123.93±92.89)vs.(70.70±61.55)μmol/L,P=0.005],direct bilirubin[(93.00±70.22)vs.(54.50±49.08)μmol/L,P=0.005],alanine aminotransferase[(108.09±87.18)vs.(28.73±13.59)U/L,P<0.001]and aspertate aminotransferase[(134.00±123.81)vs.(34.36±14.16)U/L,P=0.001]declined markedly.Two patients(5.88%)were accompanied with drainage slippage and yet without hemorrhage or biliary fistula.And two deaths(5.88%)occurred from multiple organ failure due to complex infected pancreatic necrosis.Conclusion As a simple,safe,effective and transitional operation,PTGD has some therapeutic value in AP patients with cholecystitis or biliary obstruction.

关 键 词：急性胰腺炎 经皮经肝胆囊穿刺引流 胆囊炎 胆道梗阻 

分 类 号：R657.51[医药卫生—外科学]