导丝引导法经皮经肝穿刺胆道引流术治疗急性梗阻性化脓性胆管炎的临床疗效

Efficacy of guidewire-guided percutaneous transhepatic cholangiography and drainage in the treatment of acute obstructive suppurative cholangitis

摘要:

目的 探究导丝引导法在经皮经肝穿刺胆道引流术（PTBD）治疗急性梗阻性化脓性胆管炎的临床疗效。方法 回顾性分析2018年12月—2021年12月萍乡市人民医院收治的87例急性梗阻性化脓性胆管炎患者的临床资料。按照不同置管方式分为传统穿刺组（48例）与导丝引导组（39例）。其中传统穿刺组患者行传统PTBD，导丝引导组患者行导丝引导PTBD。比较两组患者围术期的情况，术前与术后1周肝功能及胆红素水平变化，术前与术后1周血清与胆汁细胞因子水平，两组患者并发症发生情况。结果 两组患者引流手术时间、一次性置入成功、每日引流量比较，差异无统计学意义（P >0.05）。两组患者引流术前后的TBIL、DBIL和ALT的差值比较，差异无统计学意义（P >0.05）。导丝引导组引流术前后血流、胆汁IL-1、IL-4、IL-10和TNF-α上升或下降程度大于传统穿刺组（P <0.05）。两组患者胆道出血、胆漏发生率比较，差异无统计学意义（P >0.05）。传统穿刺组急性重症胆管炎、脓毒症发生率高于导丝引导组（P <0.05）。结论 传统PTBD与导丝引导法PTBD的一次性置入率相当，且均可较好地改善肝功能与胆红素水平，但导丝引导法PTBD可有效改善炎症因子水平，降低术后急性重症胆管炎与脓毒症的发生率。

Abstract:

Objective To explore the therapeutic efficacy of guidewire-guided percutaneous transhepatic biliary drainage (PTBD) for acute obstructive suppurative cholangitis.Methods The clinical data of eighty-seven patients with acute obstructive suppurative cholangitis treated in our hospital from December 2018 to December 2021 were analyzed retrospectively. According to the approach of catheterization, the patients were divided into conventional puncture group (48 cases) and guidewire guidance group (39 cases). The patients in the conventional puncture group were treated with routine PTBD, and the patients in the guidewire guidance group were treated with guidewire-guided PTBD. The perioperative conditions of the two groups of patients, as well as changes of the liver function and the bilirubin level before and 1 week after the operation, serum and bile levels of cytokines before and 1 week after the operation, and the incidence of complications in the two groups of patients were observed.Results There was no significant difference in the operative duration, first-attempt success rate of catheterizationand daily drainage volume between the two groups (P > 0.05). The differences of the levels of TBIL, DBIL and ALT before and after the PTBD were not different between the two groups (P > 0.05), whereas the differences of the serum and bile levels of IL-1, IL-4, IL-10 and TNF-α of patients before and after the PTBD in the guidewire guidance group were greater than those in the conventional puncture group (P < 0.05). There was no significant difference in the incidence of biliary bleeding and bile leakage between the two groups (P > 0.05). The incidence of acute severe cholangitis and sepsis in the conventional puncture group was higher than that in the guidewire guidance group (P < 0.05).Conclusions The first-attempt success rate of catheterization in PTBD is comparable via conventional or guidewire-guided approaches. However, guidewire-guided PTBD well regulates the levels of inflammatory factors and reduces the incidence of postoperative acute severe cholangitis and sepsis.