-
胰腺炎是临床常见的急重症之一,也是急诊科最常见的急腹症之一,病情重、进展快,严重威胁人民生命健康。急性胰腺炎的病因很多,常见的有胆源性、酒精性、不良饮食、高脂血症等,胆源性胰腺炎是最常的类型[1]。近年来,急性胰腺炎治疗取得不少进展,但是仍然效果不理想。胆源性胰腺炎病因治疗十分关键,但是病因治疗的方式仍然存在很大的争议,常见的有手术、内镜等,手术治疗方案包括开腹或经腹腔镜的胆囊切除、胆管切开引流术等[2],亦可采用经内镜鼻胆管引流术、经内镜逆行性胰胆管造影术取石或者联合胰胆管括约肌切开术等治疗手段,但是手术时间长、无法床边进行、费用高,不利于广泛开展,且危重病人常难以耐受手术,早期手术风险大。而超声引导下经皮经肝胆囊穿刺术(ultrasound guided percutaneous transhepatic gallbladder drainage, PTGD)作为一种超声介入治疗方案可以床边进行,置管后可以引流胆汁,解除胆道梗阻,从而缓解胆源性胰腺炎的病因,而是否能够利于胆源性胰腺炎的治疗目前国内相关研究较少,且尚缺乏令人信服的结果。基于此,本研究回顾性分析超声引导下PTGD术在胆源性胰腺炎中的治疗效果,现作报道。
-
观察组病人腹胀缓解时间、排气时间、胰周积液率、胰周感染率、住院时间均低于对照组,差异有统计学意义(P < 0.05~P < 0.01);2组病人胰瘘率、ARDS率、MODS率和病死率差异无统计学意义(P>0.05)(见表 1)。
分组 n 腹胀缓解时间/d 排气时间/d 胰周积液 胰周感染 胰瘘 住院时间/d ARDS MODS 病死 观察组 64 2.54±2.34 3.45±1.56 7(10.9) 3(4.7) 2(3.1) 12.32±3.56 7(10.9) 4(6.2) 1(1.6) 对照组 64 4.23±2.63 5.45±1.89 16(25.0) 10(15.6) 7(10.9) 15.34±3.78 11(17.2) 6(9.4) 2(3.1) t — 3.84 6.53 4.29* 4.20* 1.91* 4.65 1.03* 0.43* 0.34* P — < 0.01 < 0.01 < 0.05 < 0.05 >0.05 < 0.01 >0.05 >0.05 >0.05 *示χ2值 表 1 2组病人治疗后临床指标的比较[n; 百分率(%)]
-
2组病人入院时WBC、ALT、胆红素、PCT、乳酸和Balthazar CT评分差异无统计学意义(P>0.05),入院3 d和6 d时WBC、ALT、胆红素、PCT和乳酸水平观察组均低于对照组(P < 0.01),入院7 d时Balthazar CT评分观察组低于对照组(P < 0.05)(见表 2)。
指标 观察组 对照组 t P WBC/(×109/L) 0 d 18.02±3.65 17.82±3.10 0.33 >0.05 3 d 12.56±3.42 15.65±3.43 5.10 < 0.01 6 d 9.75±2.87 11.98±2.43 4.74 < 0.01 ALT/(U/L) 0 d 90.65±31.58 86.42±35.43 0.71 >0.05 3 d 60.12±23.65 75.45±23.46 3.68 < 0.01 6 d 30.87±16.68 63.45±18.43 10.49 < 0.01 胆红素/(μmol/L) 0 d 48.78±15.32 47.34±16.23 0.52 >0.05 3 d 28.45±13.34 39.78±10.45 3.84 < 0.01 6 d 12.56±7.54 20.56±8.98 5.46 < 0.01 PCT/(ng/mL) 0 d 2.35±1.5 2.54±1.89 0.63 >0.05 3 d 1.51±0.76 1.98±0.65 4.03 < 0.01 6 d 0.42±0.14 0.94±0.53 7.79 < 0.01 乳酸/(mmol/L) 0 d 3.921±1.14 4.12±1.43 0.87 >0.05 3 d 1.98±0.65 3.32±0.67 11.48 < 0.01 6 d 0.56±0.34 1.45±0.56 10.87 < 0.01 Balthazar CT评分/分 0 d 3.24±0.57 3.18±0.64 0.56 >0.05 7 d 3.47±1.37 4.06±1.89 2.02 < 0.05 表 2 2组病人实验室指标的比较
超声引导下经皮经肝胆囊穿刺引流术在急性胆源性胰腺炎治疗中的应用
Application value of percutaneous transhepatic gallbladder drainage guided by ultrasound in the treatment of acute biliary pancreatitis
-
摘要:
目的探讨超声引导下经皮经肝胆囊穿刺引流术(PTGD)对于急性胆源性胰腺炎的治疗价值。 方法选择急性胆源性胰腺炎病人128例,按是否行PTGD分为观察组(64例,行PTGD引流术)和对照组(64例,不行胆囊穿刺),2组均给予相同的常规治疗。比较2组病人治疗后指标[腹胀缓解时间、排气时间、住院时间、白细胞(WBC)、谷氨酸氨基转移酶(ALT)、总胆红素、降钙素原(PLT)、乳酸、Bahhazar CT评分]、并发症情况包括胰周积液、胰周感染、胰瘘、急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)及病死率情况。 结果与对照组比较,观察组病人腹胀缓解时间、排气时间、胰周积液率、胰周感染率、住院时间均较低,差异有统计学意义(P < 0.05~P < 0.01);2组病人胰瘘率、ARDS率、MODS率和病死率差异无统计学意义(P>0.05);实验室检查,2组病人入院时WBC、ALT、胆红素、PCT、乳酸和Balthazar CT评分差异无统计学意义(P>0.05),入院3 d和6 d时WBC、ALT、胆红素、PCT和乳酸值观察组均低于对照组,入院7 d时Balthazar CT评分值观察组低于对照组,差异均有统计学意义(P < 0.05~P < 0.01)。 结论PTGD效果好、安全性高,可明显改善急性胆源性胰腺炎治疗效果。 Abstract:ObjectiveTo explore the therapeutic value of percutaneous transhepatic gallbladder drainage(PTDG) guided by ultrasound in acute biliary pancreatitis. MethodsA total of 128 patients with acute biliary pancreatitis were divided into the observation group(64 cases treatment with PTGD) and control group(64 cases treatment without PTGD), and two groups were treated with the same routine method.After treatment, the indicators(including the abdominal distension relief time, exhaust time, hospital stay, white cells count, glutamic amino transferase, total bilirubin, procalcitonin, lactic acid and Bahhazar CT score), and complications(including peripancreatic effusion, peripancreatic infection, pancreatic fistula, ARDS, MODS incidence of effusion, peripancreatic infection, pancreatic fistula and mortality) were compared between two groups. ResultsCompared with the control group, the diarrhea remission time, exhaust time, peripancreatic effusion rate, peripancreatic infection rate and hospital stay in the observation group were low, and the differences of whose between two groups were statistically significant(P < 0.05 to P < 0.01).The differences of the pancreatic fistula rate, ARDS rate, MODS rate and mortality between two groups were not statistically significant(P>0.05).The differences of the WBC, ALT, bilirubin, PCT, lactic acid and Balthazar CT score between two groups on admission were not statistically significant(P>0.05), the levels of WBC, ALT, bilirubin, PCT and lactic acid in observation group were lower than those in control group after 3 d and 6 d of admission, and the Balthazar CT score was lower than that in observation group after 7 d of admission(P < 0.05 to P < 0.01). ConclusionsPTGD is effective and safe, and can significantly improve the therapeutic effect of acute biliary pancreatitis. -
Key words:
- acute pancreatitis /
- biliary /
- ultrasound guidance /
- puncture drainage
-
表 1 2组病人治疗后临床指标的比较[n; 百分率(%)]
分组 n 腹胀缓解时间/d 排气时间/d 胰周积液 胰周感染 胰瘘 住院时间/d ARDS MODS 病死 观察组 64 2.54±2.34 3.45±1.56 7(10.9) 3(4.7) 2(3.1) 12.32±3.56 7(10.9) 4(6.2) 1(1.6) 对照组 64 4.23±2.63 5.45±1.89 16(25.0) 10(15.6) 7(10.9) 15.34±3.78 11(17.2) 6(9.4) 2(3.1) t — 3.84 6.53 4.29* 4.20* 1.91* 4.65 1.03* 0.43* 0.34* P — < 0.01 < 0.01 < 0.05 < 0.05 >0.05 < 0.01 >0.05 >0.05 >0.05 *示χ2值 表 2 2组病人实验室指标的比较
指标 观察组 对照组 t P WBC/(×109/L) 0 d 18.02±3.65 17.82±3.10 0.33 >0.05 3 d 12.56±3.42 15.65±3.43 5.10 < 0.01 6 d 9.75±2.87 11.98±2.43 4.74 < 0.01 ALT/(U/L) 0 d 90.65±31.58 86.42±35.43 0.71 >0.05 3 d 60.12±23.65 75.45±23.46 3.68 < 0.01 6 d 30.87±16.68 63.45±18.43 10.49 < 0.01 胆红素/(μmol/L) 0 d 48.78±15.32 47.34±16.23 0.52 >0.05 3 d 28.45±13.34 39.78±10.45 3.84 < 0.01 6 d 12.56±7.54 20.56±8.98 5.46 < 0.01 PCT/(ng/mL) 0 d 2.35±1.5 2.54±1.89 0.63 >0.05 3 d 1.51±0.76 1.98±0.65 4.03 < 0.01 6 d 0.42±0.14 0.94±0.53 7.79 < 0.01 乳酸/(mmol/L) 0 d 3.921±1.14 4.12±1.43 0.87 >0.05 3 d 1.98±0.65 3.32±0.67 11.48 < 0.01 6 d 0.56±0.34 1.45±0.56 10.87 < 0.01 Balthazar CT评分/分 0 d 3.24±0.57 3.18±0.64 0.56 >0.05 7 d 3.47±1.37 4.06±1.89 2.02 < 0.05 -
[1] 赵登秋, 邬叶锋, 程邦君, 等, 急性胰腺炎217例病因与临床诊治分析[J].中华肝胆外科杂志, 2012, 18(8):615. [2] TSAI TJ, CHAN HH, LAI KH, et al.Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment?[J].BMC Gastroenterol, 2018, 18(1):32. doi: 10.1186/s12876-018-0762-6 [3] 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华普通外科杂志, 2015, 30(1):69. [4] 周鑫滨, 王贵锋, 钱维明.不伴胆道梗阻的急性重症胰腺炎策略性清创治疗62例分析[J].中华急诊医学杂志, 2016, 25(9):1191. [5] 沈凤, 王保健, 顾文芳.ERCP治疗急性膜腺炎疗效及其术后并发症的影响因素分析[J].陕西医学杂志, 2018, 47(8):984. [6] 孙备, 冀亮.重症急性胰腺炎外科干预应重视的问题[J].中华消化外科杂志, 2017, 16(10):987. [7] 周祖邦, 哈继伟, 李淑兰, 等, 超声引导下联合置管治疗急性胆源性胰腺炎的探讨[J].中国超声医学杂志, 2015, 31(3), 340.