ERCP治疗急性梗阻性化脓性胆管炎患者疗效研究  

Comparison of ERCP and open surgery in the treatment of patients with acute obstructive suppurative cholangitis:A single center study

作　　者：何晓非[1] 陈杰[1] 罗国松 陆世峰 He Xiaofei;Chen Jie;Luo Guosong(Department of Hepatobiliary Surgery,Fourth People's Hospital,Zigong 643000,Sichuan Province,China)

机构地区：[1]四川省自贡市第四人民医院肝胆外科,643000 [2]广西中医药大学第一附属医院肝胆外科

出　　处：《实用肝脏病杂志》2024年第2期291-294,共4页Journal of Practical Hepatology

摘　　要：目的探讨内镜下逆行胰胆管造影术(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法2020年1月~2023年1月我院收治的AOSC患者103例,其中观察组58例接受ERCP治疗,对照组45例接受开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度,采用ELISA法检测血清白细胞介素(IL)-6、IL-1、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP)水平。结果观察组术中出血量、手术时间、术后3 d VAS评分和术后住院日分别为(30.7±4.6)mL、(74.3±8.8)min、(3.1±0.8)分和(7.2±1.4)d,均显著短于或少于对照组【分别为(85.4±10.2)mL、(117.6±12.5)min、(4.9±1.1)分和(13.3±3.7)d,P<0.05】;在术后5 d,观察组血清ALT和GGT水平分别为(48.2±4.1)U/L和(163.9±17.2)U/L,均显著低于对照组【分别为(66.9±5.3)U/L和(189.6±21.5)U/L,P<0.05】;观察组血清IL-6、IL-1、TNF-α和CRP水平分别为(82.6±8.3)ng/L、(20.9±4.0)ng/L、(16.2±3.5)ng/L和(18.1±2.2)mg/L,均显著低于对照组【分别为(100.7±11.2)ng/L、(32.7±5.3)ng/L、(23.6±4.3)ng/L和(32.9±4.8)mg/L,P<0.05】;观察组并发症发生率为5.1%,显著低于对照组的17.8%(P<0.05)。结论采用ERCP治疗AOSC患者效果好,术后恢复快,并发症发生率低,值得临床应用。Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)and open surgery in the treatment of patients with acute obstructive suppurative cholangitis(AOSC).Methods A total of 103 patients with AOSC were encountered in our hospital between January 2020 and January 2023,and 58 patients in observation group received ERCP therapy and 45 patients in control group received open laparotomy.The pain was evaluated by visual analogue scale(VAS),and serum interleukin(IL)-6,IL-1,tumor necrosis factor(TNF)-αand C-reactive protein(CRP)levels were detected by ELISA.Results The intraoperative blood loss,operation time,VAS score at day three after surgery and hospitalization stay in the observation group were(30.7±4.6)mL,(74.3±8.8)min,(3.1±0.8)and(7.2±1.4)d,all significantly less or shorter than[(85.4±10.2)mL,(117.6±12.5)min,(4.9±1.1)and(13.3±3.7)d,respectively,P<0.05]in the control;at day five after surgery,serum ALT and GGT levels in the observation group were(48.2±4.1)U/L and(163.9±17.2)U/L,both significantly lower than[(66.9±5.3)U/L and(189.6±21.5)U/L,respectively,P<0.05]in the control;serum IL-6,IL-1,TNF-αand CRP levels in the observation were(82.6±8.3)ng/L,(20.9±4.0)ng/L,(16.2±3.5)ng/L and(18.1±2.2)mg/L,all significantly lower than[(100.7±11.2)ng/L,(32.7±5.3)ng/L,(23.6±4.3)ng/L and(32.9±4.8)mg/L,respectively,P<0.05]in the control;the incidence of post-operational complications in the observation group was significantly lower than that in the control group(5.1%vs.17.8%,P<0.05).Conclusion The ERCP therapy was successfully completed in our series,and it could deal emergently or urgently with patients with AOSC,which warrants further clinical investigation.

关 键 词：急性梗阻性化脓性胆管炎 内镜下逆行胰胆管造影术 细胞因子 治疗 

分 类 号：R575.7[医药卫生—消化系统]