急性梗阻化脓性胆管炎的内镜治疗及细菌感染对预后的影响

发布时间：2018-02-25 15:28

本文关键词： 急性梗阻化脓性胆管炎病原菌内镜肝脏功能　出处：《中华医院感染学杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨急性梗阻化脓性胆管炎(AOSC)的内镜治疗及细菌感染对预后的影响,为临床合理指导AOSC患者的内镜下治疗提供更多循证医学证据。方法选取2013年1月-2016年10月医院收治的AOSC患者310例;依据手术方式不同,分为内镜组140例和对照组170例;内镜组患者行逆行胰胆管造影(ERCP)配合内镜鼻胆管引流术(ENBD);对照组患者行传统手术治疗(胆管切开减压+T管引流术),比较两组患者的临床疗效,细菌感染的病原学分布特点及对预后的影响。结果两组患者在性别、年龄、发病至就诊时间和术前肝功指标上比较差异均无统计学意义;内镜组患者的治愈率为94.28%,显著高于对照组的87.64%;内镜组患者黄疸减轻时间、腹痛缓解时间、引流管拔除时间及总住院时间均短于对照组,差异有统计学意义(P0.05);与术前相比,术后两组患者肝功丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)明显降低,白蛋白(ALB)水平显著升高(P0.05);炎症因子超敏C-反应蛋白(hs-CRP)水平显著下降(P0.05);且术后内镜组ALT、AST和hs-CRP水平与对照组比较,差异均有统计学意义(P0.05)。结论内镜治疗AOSC患者的疗效优于传统手术治疗,合并细菌感染的病原菌分布特点并非影响患者手术方式及预后的主要因素。
[Abstract]:Objective to investigate the endoscopic treatment of acute obstructive suppurative cholangitis (AOSC) and the effect of bacterial infection on prognosis. Methods 310 patients with AOSC were selected from January 2013 to October 2016, who were divided into endoscopic group (n = 140) and control group (n = 170). The patients in the endoscopic group were treated with retrograde cholangiopancreatography (ERCP) combined with endoscopic nasobiliary drainage (ENBDD), while the patients in the control group were treated with traditional surgical treatment (cholangiotomy and decompression of T-tube drainage), and the clinical efficacy of the two groups was compared. Results there was no significant difference in sex, age, time from onset to visit and preoperative liver function between the two groups. The cure rate of the patients in the endoscopic group was 94.28, which was significantly higher than that in the control group (87.64). The time for relieving jaundice, relieving abdominal pain, extubation of drainage tube and total hospital stay in the endoscopic group were shorter than those in the control group (P 0.05). The levels of alt, AST, TBILs and TBILs were significantly decreased in the two groups after operation. The levels of Alb and hs-CRP in the endoscopic group were significantly higher than those in the control group, and the levels of inflammatory factor hypersensitive C-reactive protein hs-CRP were significantly decreased in the endoscopy group, and compared with the control group, the levels of alt and hs-CRP in the endoscopic group were significantly lower than those in the control group. Conclusion Endoscopic treatment of AOSC patients is more effective than traditional surgical treatment, and the distribution of pathogenic bacteria associated with bacterial infection is not the main factor affecting the operation mode and prognosis of the patients.
【作者单位】：温岭市第一人民医院消化内科;温岭市第一人民医院肝胆外科;
【基金】：浙江省医学会临床科研基金资助项目(2011ZYC-A02)
【分类号】：R657.4

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