ENBD和PTCD在胆石性急性重症胆管炎中的应用及中药清热利胆颗粒的干预作用
发布时间：2019-06-27 08:49
【摘要】：目的:探讨在内镜下鼻胆管引流术(ENBD)或经皮经肝穿刺胆道引流术(PTCD)在急性重症胆管炎(ACST)中的应用及中药清热利胆颗粒(QRLD)的干预作用;方法:选取2013年1月至2017年1月我科收治的行ENBD或PTCD胆道减压引流的ACST患者为研究对象,依据1983年全国胆道外科疾病专题讨论会,所有患者均符合急性重症胆管炎的诊断标准。依据是否应用院内制剂清热利胆颗粒(QRLD)将患者分为四组:ENBD组患者单纯行内镜下鼻胆管引流治疗;ENBD联合QRLD组患者行ENBD后予以中药清热利胆颗粒辅助治疗;PTCD组患者单纯行PTCD引流治疗;PTCD联合QRLD组患者行PTCD引流后予以中药清热利胆颗粒辅助治疗。对四组患者术前与术后一周炎症水平(白细胞总数、粒细胞百分比)、黄疸水平(总胆红素)及肝功能(ALT、AST)、术后引流量、体温等指标进行统计学分析,评估清热利胆颗粒对ENBD或PTCD引流的辅助作用;对各组患者术后总有效率及死亡率、并发症发生率进行统计学分析,观察清热利胆颗粒辅助治疗ACST的疗效。结果:2013年1月至2017年1月我科共收治的并行ENBD或PTCD患者共96例,所有患者均符合急性重症胆管炎(ACST)的诊断标准,依据其严重程度可分为:Ⅰ级52例、Ⅱ级22例、Ⅲ级6例、Ⅳ级16例。单纯行胆道减压引流术61例,包括ENBD治疗33例和PTCD治疗28例;其余35例患者术后予以口服清热利胆颗粒,包括ENBD治疗联合清热利胆颗粒治疗19例和PTCD联合清热利胆颗粒治疗16例。统计显示,四组患者年龄、性别、发病原因、伴发疾病、合并症和既往胆道手术史等一般状况没有显著差别(P0.05);四组患者术后一周炎症水平(白细胞总数、粒细胞百分比)、黄疸水平(总胆红素)及肝功能(ALT、AST)等指标均比术前明显好转(P0.05),对应两组间比较,中药联合观察组患者炎症水平和黄疸水平下降程度比单纯ENBD或PTCD治疗更低(P0.05);术后总有效率及死亡率、并发症发生率等与单纯引流组相比,中药联合组患者总有效率明显提高且并发症发生率更低(P0.05)。结论:急性重症胆管炎发病急骤、病情进展迅速,早期容易并发脓毒血症至感染性休克、呼吸衰竭、多脏器功能衰竭而致患者临床死亡。治疗ACST的关键是早期进行胆道减压、畅通引流,ENBD和PTCD都是有效的胆道减压引流措施,可迅速缓解病情、提高ACST患者的生存率;清热利胆是祖国医学治疗梗阻性急性重症胆管炎的重要方法,在胆道减压引流术后应用清热利胆颗粒(QRLD)可以增强ENBD和PTCD胆道减压引流效果,有效减少ERCP术后胰腺炎的发生、促进引流术后患者炎症水平的降低和肝功能的恢复,疗效肯定,值得在临床推广应用。
[Abstract]:Objective: to investigate the application of endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic bile duct drainage (PTCD) in acute severe cholangitis (ACST) and the intervention effect of Qingre Lidan granule (QRLD). Methods: from January 2013 to January 2017, ACST patients undergoing ENBD or PTCD bile duct decompression and drainage were selected as the subjects. According to the 1983 National Symposium on Biliary Surgical Diseases, all patients met the diagnostic criteria of acute severe cholangitis. The patients were divided into four groups according to whether or not the hospital preparation Qingre Lidan granule (QRLD) was used: the patients in ENBD group were treated with endoscopic nasobiliary drainage alone; the patients in ENBD combined with QRLD group were treated with Qingre Lidan granule after ENBD; the patients in PTCD group were treated with PTCD drainage alone; and the patients in PTCD group were treated with traditional Chinese medicine Qingre Lidan granule after PTCD drainage. The inflammatory level (total leukocyte count, granulocyte percentage), jaundice level (total bilirubin), liver function (ALT,AST), postoperative drainage volume and body temperature of the four groups were statistically analyzed before and one week after operation, and the auxiliary effect of Qingre Lidan granule on ENBD or PTCD drainage was evaluated. The total effective rate, mortality and incidence of complications in each group were statistically analyzed, and the curative effect of Qingre Lidan granule in the treatment of ACST was observed. Results: from January 2013 to January 2017, a total of 96 patients with ENBD or PTCD were treated in our department. All patients met the diagnostic criteria of (ACST). According to their severity, they could be divided into grade 鈪，
本文编号：2506657
[Abstract]:Objective: to investigate the application of endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic bile duct drainage (PTCD) in acute severe cholangitis (ACST) and the intervention effect of Qingre Lidan granule (QRLD). Methods: from January 2013 to January 2017, ACST patients undergoing ENBD or PTCD bile duct decompression and drainage were selected as the subjects. According to the 1983 National Symposium on Biliary Surgical Diseases, all patients met the diagnostic criteria of acute severe cholangitis. The patients were divided into four groups according to whether or not the hospital preparation Qingre Lidan granule (QRLD) was used: the patients in ENBD group were treated with endoscopic nasobiliary drainage alone; the patients in ENBD combined with QRLD group were treated with Qingre Lidan granule after ENBD; the patients in PTCD group were treated with PTCD drainage alone; and the patients in PTCD group were treated with traditional Chinese medicine Qingre Lidan granule after PTCD drainage. The inflammatory level (total leukocyte count, granulocyte percentage), jaundice level (total bilirubin), liver function (ALT,AST), postoperative drainage volume and body temperature of the four groups were statistically analyzed before and one week after operation, and the auxiliary effect of Qingre Lidan granule on ENBD or PTCD drainage was evaluated. The total effective rate, mortality and incidence of complications in each group were statistically analyzed, and the curative effect of Qingre Lidan granule in the treatment of ACST was observed. Results: from January 2013 to January 2017, a total of 96 patients with ENBD or PTCD were treated in our department. All patients met the diagnostic criteria of (ACST). According to their severity, they could be divided into grade 鈪，
本文编号：2506657
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