首页|经内镜逆行胰胆管造影联合经皮肝胆管引流术在治疗高龄患者胆总管结石引起胆管炎的临床研究

经内镜逆行胰胆管造影联合经皮肝胆管引流术在治疗高龄患者胆总管结石引起胆管炎的临床研究

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目的 探讨经内镜逆行胰胆管造影(ERCP)联合经皮肝穿刺胆道引流术(PTCD)治疗高龄胆总管结石致胆管炎患者的临床疗效.方法 本研究观察对象为高龄胆总管结石致胆管炎患者,共60例,收治时间为2023年1月至2024年1月间.通过随机数字表法进行分组,对照组30例患者接受PTCD治疗,观察组30例患者PTCD联合ERCP治疗.比较两组患者的生存质量、肝胆生化指标、炎症指标水平变化,同时比较两组临床症状缓解时间.结果 术后观察组消化系统疾病生存质量指数量表(GLQI)总分高于对照组[(127.03±6.52)分比(105.81±5.46)分],差异有统计学意义(t=13.667,P<0.05);术后观察组血清总胆红素(TBiL)、直接胆红素(DBil)为、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)均低于对照组[(34.98±3.75)μmol/L、(24.69±3.81)μmol/L、(64.79±5.86)U/L、(61.09±4.36)U/L 比(58.42±7.62)µmol/L、(37.12±4.54)μmol/L、(77.13±9.32)U/L、(90.12±7.71)U/L],差异有统计学意义(t=15.117、11.487、6.139、17.952,P<0.05);观察组白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)水平低于对照组[(13.08±1.09)×109/L、(1.49±0.38)mg/L、(29.54±2.71)μg/L 比(15.73±1.16)× 109/L、(2.08±0.51)mg/L、(36.48±3.38)µg/L],差异有统计学意义(t=9.119、5.081、8.774,P<0.05);观察组腹痛缓解时间、发热缓解时间以及黄疸消退时间均短于对照组[(4.43±0.52)、(1.99±0.32)、(2.43±0.46)d 比(5.89±0.97)、(2.87±0.46)、(3.15±0.61)d],差异有统计学意义(t=7.266、8.602、5.162,P<0.05).结论 高龄患者胆总管结石致胆管炎应用ERCP联合PTCD治疗的效果可观,具有应用价值.
Clinical value of encoscopic retrograde cholangio-pancreatography combined with percutaneous transhepatic cholangial drainage in the treatment of elderly patients with cholangitis caused by com-mon bile duct stones
Objective Exploring the clinical efficacy of Endoscopic Retrograde Cholangiopancre-atography combined with Percutaneous Transhepatic Cholangioplasty and Drainage in the treatment of elder-ly patients with cholangitis caused by common bile duct stones.Methods The study observed 60 elderly patients with cholangitis caused by common bile duct stones,who were admitted between January 2023 and January 2024.By using a random number table method,30 patients in the control group received PTCD treatment,while 30 patients in the observation group received PTCD combined with ERCP treatment.com-pare the changes in quality of life,liver and gallbladder biochemical indicators,and inflammatory indica-tors between two groups of patients,and also compare the time for clinical symptom relief between the two groups.Results The total score of the digestive system disease quality of life index(GLQI)in the postop-erative observation group was higher than that in the control group[(127.03±6.52)points compared to(105.81±5.46)points],and the difference was statistically significant(t=13.667,P<0.05);The ser-um total bilirubin(TBiL),direct bilirubin(DBil),alanine aminotransferase(ALT),and aspartate amin-otransferase(AST)in the postoperative observation group were all lower than those in the control group[(34.98±3.75)μ mol/L,(24.69±3.81)μ mol/L,(64.79±5.86)U/L,(61.09±4.36)U/L vs.(58.42±7.62)μ mol/L,(37.12±4.54)μ mol/L,(77.13±9.32)U/L,(90.12±7.71)U/L],and the differences were statistically significant(t=15.117,11.487,6.139,17.952,P<0.05);The white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)levels in the observation group were lower than those in the control group[(13.08±1.09)×109/L,(1.49±0.38)mg/L,(29.54±2.71)μg/L vs.(15.73±1.16)×109/L,(2.08±0.51)mg/L,(36.48±3.38)μg/L],and the differences were statistically significant(t=9.119,5.081,8.774,P<0.05);The relief time of abdominal pain,fever,and jaundice in the observation group were shorter than those in the control group[(4.43±0.52),(1.99±0.32),(2.43±0.46)d vs.(5.89±0.97),(2.87±0.46),(3.15±0.61)d],and the difference was statistically significant(t=7.266,8.602,5.162,P<0.05).Conclusion The use of ERCP combined with PTCD for the treatment of cholangitis caused by common bile duct stones in elderly patients is a statistical difference in the effect,and the effect is effective and has practical value.

Encoscopic retrograde cholangio-pancreatographyPercutaneous transhepatic cholangial drainageAdvanced ageCommon bile duct stonesCholangitis

孙明飞、刘亚龙、李静、段文飞

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河南大学第一附属医院心血管外科,开封 475000

江苏大学附属句容医院普通外科,句容 212400

经内镜逆行胰胆管造影 经皮肝胆管引流术 高龄患者 胆总管结石 胆管炎

2024

中华实验外科杂志
中华医学会

中华实验外科杂志

CSTPCD
影响因子:0.759
ISSN:1001-9030
年,卷(期):2024.41(12)