急性梗阻性化脓性胆管炎（AOSC）的治疗方法选择的临床研究
发布时间：2018-10-09 09:57
【摘要】：目的： 比较胆管切开减压、T管引流术；ERCP+EST+ENBD术；PTCD术对急性梗阻性化脓性胆管炎(AOSC)患者的治疗效果,为临床治疗AOSC手术方式选择提供依据。 方法： 收集昆明医科大学第二附属医院肝胆外二科2012年1月-2012年12月间56例急性梗阻性化脓性胆管炎患者的临床资料。其中：1、胆管切开减压、T管引流术者21例(A组)；2、ERCP+EST+ENBD者13例(B组)：3、PTCD术者22例(C组)。术前及术后均进行控制感染,抗休克,纠正水、电解质、酸碱平衡紊乱,积极治疗原有合并疾病。分析比较各组手术方式患者术前24小时、术后24小时、72小时、1周、2周时的总胆红素、丙氨酸氨基转移酶(ALT)、感染性休克症状、神经系统受抑制症状、并发症率、死亡率、住院天数。应用SPSS17.0版软件,数据采用x±s表示,各组计量资料间比较采用t检验,以P0.05为有统计学意义。 结果： 1.术后72h内,胆管切开减压、T管引流术组(A组)总胆红素、丙氨酸氨基转移酶(ALT)减退效果较ERCP+EST+ENBD术组(B组)更好,术后1周时两组比较无差异；24h内A组感染性休克和神经系统受抑制症状较B组组缓解明显,但术后72h后,A组、B组比较无差异；A组死亡4例；A组并发症发生率和死亡率明显高于B组；A组住院天数明显较B组短。 2.术后1周内,胆管切开减压、T管引流术组(A组)总胆红素、丙氨酸氨基转移酶(ALT)减退效果较PTCD术组(C组)更好,术后2周两组比较无差异；24h内A组感染性休克和神经系统受抑制症状较C组缓解更明显,但术后72h后,A组、B组比较无差异;A组并发症发生率和死亡率明显高于C组；A组住院天数明显较C组短。 3.ERCP+EST+ENBD术组(B组)与PTCD组(C组)比较,在总胆红素减退、丙氨酸氨基转移酶降低、感染性休克及神经系统受抑制症状持续缓解方面无统计学意义：术后并发症、死亡率也无统计学意义：B组住院天数较C组短。 结论： 1.PTCD术能充分引流胆汁,解除胆道压力,解除胆道梗阻效果理想。而且此手术创伤小、操作较简便、手术时间短、无需全身麻醉,术后并发症、死亡率较低等。符合损伤控制外科(DCS)的原则。缓解了AOSC患者危机症状,为二次去除病因的彻底手术创造条件。PTCD术适用症：肝内外胆管结石并引起胆管扩张的AOSC患者。 2. ERCP+EST+ENBD术能解除部分AOSC患者的胆总管下端的梗阻,能较充分引流胆汁,降低胆管压力,缓解AOSC患者的危急症状。手术创伤小,术后恢复快。适用症：胆总管下端结石引起梗阻的AOSC患者。禁忌症：患者年龄较大,感染性休克及精神症状较重,有心、脑、血管、肺部等并发疾病。 3.胆道切开减压、T管引流术也能充分引流胆汁,立即解除胆道压力,同时可在直视下发现并解除部分梗阻病因。但因手术创伤较大,形成二次打击,且麻醉对呼吸、血液循环影响导致患者死亡率及术后并发症发生率最高。适用症：无法行ERCP+EST+ENBD术治疗,PTCD术穿刺失败的AOSC患者。禁忌症：患者年龄较大,感染性休克及精神症状较重,有心、脑、血管、肺部等并发疾病。
[Abstract]:Purpose: Comparison of bile duct incision decompression, T-tube drainage; ERCP + EST + ENBD; treatment effect of PTCD for patients with acute obstructive purulent cholangitis (AOSC). Basis. Methods: From January 2012 to December 2012, 56 cases of acute obstructive purulent cholangitis were collected from the second Affiliated Hospital of Kunming Medical University from January 2012 to December 2012. Among them, 21 cases (group A), 2 ERCP + EST + ENBD 13 cases (group B): 3, PTCD operation. 22 patients (group C) underwent control infection, anti-shock, correction of water, electrolyte and acid-base balance disorder before and after operation. The total bilirubin, alanine aminotransferase (ALT), septic shock symptom, nervous system inhibited symptom and complication rate were analyzed in 24 hours, 24 hours, 72 hours, 1 week and 2 weeks before operation. Mortality and hospitalization days. The software of SPSS1.7. 0 was used. The data was expressed by x/ s, and t-test was used for each group of measurement data to P0. 0. 5 is available Results: 1. After operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of ERCP + EST + ENBD group (group B). There was no difference between the two groups at 1 week after operation, but there was no difference in group A and group B after 72h after operation, but there was no difference in group A and group B after operation, 4 cases died in group A, and the incidence and death rate of complication in group A were significantly higher than that in group B. In group A, the number of days of hospitalization in group A was significantly shorter than that in group B. In 1 week after operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of PTCD group (group A). In group C, there was no difference between group A and group B after 2 weeks after operation, but there was no difference between group A and group B after 72h after operation, but there was no difference in group A and group B after operation. Compared with group C, the number of days in group A was significantly shorter than that in group C. 3. ERCP + EST + ENBD group (group B) was compared with PTCD group (group C). Learning significance: Postoperative complications, death the rate of death also No statistical significance: The number of days of hospitalization in group B was shorter than that in group C. Conclusion: 1. PTCD The operation is small, and the operation is simple and convenient. and the operation time is short, the whole body anesthesia is not needed, and the operation time is short, It has low mortality and lower mortality. It is consistent with the principle of injury control surgery (DCS). The symptoms of crisis in patients with OSC provide conditions for the complete operation of secondary removal of the cause. PTCD Intraoperative treatment: an AOSC patient with extrahepatic bile duct stones and dilatation of the bile duct. ERCP + EST + ENBD can relieve obstruction of the lower end of the common bile duct of some AOSC patients, can fully drain the bile and reduce the gall bladder Tube pressure to relieve emergency symptoms of AOSC patients. Small surgical trauma Post-operative recovery is fast. Applicable: AOSC patients with obstruction due to common bile duct stones. Contraindications: Patients are older "Infectious shock and mental symptoms are heavier, and complicated diseases such as brain, brain, blood vessel, lung, etc. 3. The decompression and drainage of T-tube can also be sufficient." Drainage of bile can immediately relieve the pressure of biliary tract, and can find and relieve the cause of partial obstruction at the same time. and the effect of anesthesia on respiration and blood circulation leads to the highest incidence of mortality and postoperative complications in patients. Treatment with RCP + EST + ENBD, AOSC patients with failed PTCD puncture. Contraindications: Patient Yea
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.41
本文编号：2258918
[Abstract]:Purpose: Comparison of bile duct incision decompression, T-tube drainage; ERCP + EST + ENBD; treatment effect of PTCD for patients with acute obstructive purulent cholangitis (AOSC). Basis. Methods: From January 2012 to December 2012, 56 cases of acute obstructive purulent cholangitis were collected from the second Affiliated Hospital of Kunming Medical University from January 2012 to December 2012. Among them, 21 cases (group A), 2 ERCP + EST + ENBD 13 cases (group B): 3, PTCD operation. 22 patients (group C) underwent control infection, anti-shock, correction of water, electrolyte and acid-base balance disorder before and after operation. The total bilirubin, alanine aminotransferase (ALT), septic shock symptom, nervous system inhibited symptom and complication rate were analyzed in 24 hours, 24 hours, 72 hours, 1 week and 2 weeks before operation. Mortality and hospitalization days. The software of SPSS1.7. 0 was used. The data was expressed by x/ s, and t-test was used for each group of measurement data to P0. 0. 5 is available Results: 1. After operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of ERCP + EST + ENBD group (group B). There was no difference between the two groups at 1 week after operation, but there was no difference in group A and group B after 72h after operation, but there was no difference in group A and group B after operation, 4 cases died in group A, and the incidence and death rate of complication in group A were significantly higher than that in group B. In group A, the number of days of hospitalization in group A was significantly shorter than that in group B. In 1 week after operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of PTCD group (group A). In group C, there was no difference between group A and group B after 2 weeks after operation, but there was no difference between group A and group B after 72h after operation, but there was no difference in group A and group B after operation. Compared with group C, the number of days in group A was significantly shorter than that in group C. 3. ERCP + EST + ENBD group (group B) was compared with PTCD group (group C). Learning significance: Postoperative complications, death the rate of death also No statistical significance: The number of days of hospitalization in group B was shorter than that in group C. Conclusion: 1. PTCD The operation is small, and the operation is simple and convenient. and the operation time is short, the whole body anesthesia is not needed, and the operation time is short, It has low mortality and lower mortality. It is consistent with the principle of injury control surgery (DCS). The symptoms of crisis in patients with OSC provide conditions for the complete operation of secondary removal of the cause. PTCD Intraoperative treatment: an AOSC patient with extrahepatic bile duct stones and dilatation of the bile duct. ERCP + EST + ENBD can relieve obstruction of the lower end of the common bile duct of some AOSC patients, can fully drain the bile and reduce the gall bladder Tube pressure to relieve emergency symptoms of AOSC patients. Small surgical trauma Post-operative recovery is fast. Applicable: AOSC patients with obstruction due to common bile duct stones. Contraindications: Patients are older "Infectious shock and mental symptoms are heavier, and complicated diseases such as brain, brain, blood vessel, lung, etc. 3. The decompression and drainage of T-tube can also be sufficient." Drainage of bile can immediately relieve the pressure of biliary tract, and can find and relieve the cause of partial obstruction at the same time. and the effect of anesthesia on respiration and blood circulation leads to the highest incidence of mortality and postoperative complications in patients. Treatment with RCP + EST + ENBD, AOSC patients with failed PTCD puncture. Contraindications: Patient Yea
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.41
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