不同胆道引流技术治疗胆总管结石并发急性胆管炎的回顾性研究

doi:10.16139/j.1007-9610.2025.03.08

摘要/Abstract

摘要：

目的回顾性分析胆总管结石并发急性胆管炎经内镜胆管支架引流术（ERBD）、经内镜鼻胆管引流术（ENBD）或经皮经肝胆管穿刺引流术（PTCD）等微创治疗方法的效果及安全性，探讨该类疾病的微创治疗策略。方法选取2019年1月至2020年12月我院急诊外科收治的胆总管结石并发急性胆管炎病人151例，根据包括非手术治疗方式在内的4种治疗方案将病人分为4组，比较治疗前后白细胞、胆色素、肝功能变化，以及不同手术治疗方法的术后恢复情况、并发症发生率、住院天数及预后。结果胆总管结石并发急性胆管炎ERBD和ENBD术后白细胞计数、中性粒细胞比例、肝功能明显改善，ERBD、ENBD、PTCD术后总胆红素和直接胆红素明显下降（P<0.05）。且与保守治疗相比术后恢复快，并发症少，住院天数短，死亡率低。结论 ERBD和ENBD作为治疗胆总管结石合并急性胆管炎的微创手段，具有显著的疗效，且安全可靠，能有效提高远期微创治愈率，因此是优先选择的治疗策略。根据病人的具体情况，如感染程度、结石大小、是否口服抗凝药物等因素，临床医师可制定个体化的微创治疗方案，以确保实现最佳治疗目标。

关键词: 胆总管结石, 急性胆管炎, 经内镜胆道支架引流术, 经内镜鼻胆管引流术, 经皮经肝胆管穿刺引流术

Abstract:

Objective To analyze the efficacy and safety of different minimally invasive operations[endoscopic re-trogradebiliary drainage(ERBD)、endoscopic nasobiliary drainage(ENBD)、percutaneous transhepatic cholangial drainage(PTCD)] for choledocholithiasis complicated with acute cholangitis to provide reference for clinical treatment retrospectively. Methods A total of 151 patients with choledocholithiasis complicated with acute cholangitis at Department of Emergency Surgery in our hospital from January 2019 to December 2020 were included and divided into four groups based on the four treatment strategies, including non-surgical treatment. Changes in leukocyte count, bilirubin levels, and liver function before and after treatment, as well as postoperative recovery, complication rates, length of hospital stay, and prognosis were compared among patients who underwent different surgical treatments. Results There were significant improvements in leukocyte count, percentage of neutrophils, and liver function of the patients underwent ENBD or ERBD operation (P<0.05). The total bilirubin and direct bilirubin were significantly reduced after ERBD, ENBD, and PTCD operations (P<0.05). Patients undergoing ERBD, ENBD, or PTCD demonstrated faster recovery times, fewer complications, shorter hospital stays, and lower mortality rates compared to those managed conservatively. Conclusions ERBD and ENBD as minimally invasive therapeutic modalities for the management of choledocholithiasis complicated with acute cholangitis, exhibit remarkable clinical efficacy, coupled with a high degree of safety and reliability. These techniques significantly enhance the long-term minimally invasive cure rate, thereby establishing them as the preferred treatment strategies. Tailored to the patient's specific clinical conditions, such as the severity of infection, stone dimensions, and the use of oral anticoagulant therapy, clinicians can formulate individualized minimally invasive treatment strategies, facilitating the optimal attainment of therapeutic objectives.

Key words: Choledocholithiasis, Acute cholangitis, Endoscopic retrogradebiliary drainage(ERBD), Endoscopic nasobiliary drainage(ENBD), Percutaneous transhepatic cholangial drainage(PTCD)

中图分类号:

隋亮, 陈胜, 刘远滨, 黄梁, 毛恩强, 韩意, 孙思磊, 张勇. 不同胆道引流技术治疗胆总管结石并发急性胆管炎的回顾性研究[J]. 外科理论与实践, 2025, 30(03): 228-233.

SUI Liang, CHEN Sheng, LIU Yuanbin, HUANG Liang, MAO Enqiang, HAN Yi, SUN Silei, ZHANG Yong. Retroscpective studies of different biliary drainage techniques in treatment of choledocholithiasis complicated with acute cholangitis[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 228-233.

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Item		Treatment				χ²/z/t value	P value
Item		Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)	χ²/z/t value	P value
Age（years）		78.4±9.9	75.6±11.9	72.1±12.6	69.4±13.5	1.528	0.210
Gender	Male	3（42.9）	2（40.0）	20（64.5）	66（61.1）	2.010	0.570
Gender	Female	4（57.1）	3（60.0）	11（35.5）	42（38.9）	2.010	0.570
Complications（case）	Diabetes	2（28.6）	1（20.0）	7（22.6）	20（18.5）	5.599	0.779
	Coronary heart disease	1（14.3）	0	5（16.1）	7（6.5）
	Hypertension	1（14.3）	3（60.0）	16（51.6）	46（42.6）
	Atrial fibrillation	0	0	3（9.7）	4（3.7）
Temperature（℃）		37.0±0.5	37.3±1.2	37.3±1.1	37.3±0.7	0.385	0.764
WBC(×10⁹/L)		9.0±3.8	12.9±4.3	10.2±3.9	12.6±6..0	2.274	0.082
N%（%）		78.6±20.3	89.3±3.1	85.8±8.1	87.1±8.5	2.070	0.107
TBil (μmol/L)		55.5±37.1	123.3±45.9	70.7±46.5	99.3±94,2	1.619	0.187
DBil (μmol/L)		29.4±22.4	79.9±27.9	39.9±28.7	65.1±111.6	0.848	0.47
ALT(IU/L)		153.7±95.4	193.0±145.1	264.5±212.3	342.7±247.8	2.502	0.062
AST(IU/L)		226.7±177.6	205.6±109.0	309.8±365.0	364.1±334.1	0.816	0.487
GGT(IU/L)		211.1±170.7	475.8±463.6	445.5±274.6	514.2±399.6	1.582	0.196
Severity degree	Ⅰ	1（14.3）	1（20.0）	4（12.9）	23（21.3）	3.966	0.681
	Ⅱ	4（57.1）	4（80.0）	19（61.3）	68（63.0）
	Ⅲ	2（28.6）	0（0.0）	8（25.8）	17（15.7）

Item	Treatment				χ² value	P value
Item	Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)	χ² value	P value
Hospitalization days	12.0±13.2	5.4±1.1	5.4±2.0	5.9±4.3	4.15	0.007
Fasting days	7.4±14.4	1.8±0.8	1.3±0.5	1.8±1.4	7.56	0.000

Item	Before or after treatment	Treatment
Item	Before or after treatment	Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)
WBC（×10⁹/L）	Before	9.0±3.8	12.9±4.3	10.2±3.9	12.6±6.0
	After	6.8±4.7	10.5±5.4	7.2±3.6	8.0±4.3
	t value	1.089	0.748	5.224	9.982
	P value	0.318	0.496	0.000	0.000
N%(%)	Before	78.6±20.3	89.3±3.1	85.8±8.1	87.1±8.5
	After	78.8±19.9	80. 8±10.4	71.9±11.5	74.9±11.0
	t value	-0.031	1.677	6.363	11.085
	P value	0.977	0.169	0.000	0.000
TBil(μmol/L)	Before	55.5±37.1	123.3±45.9	70.7±46.5	99.3±94.2
	After	57.0±45.3	64.1±38.2	41.8±30.9	58.0±80.5
	t value	-0.111	13.28	4.923	8.535
	P value	0.915	0.000	0.000	0.000
DBil(μmol/L)	Before	29.4±22.4	79.9±27.9	39.9±28.7	65.1±111.6
	After	31.9±28.7	30.4±22.8	19.4±19.9	26.7±40.4
	t value	-0.216	12.931	5.316	3.851
	P value	0.836	0.000	0.000	0.000
ALT(IU/L)	Before	153.7±95.4	193.0±145.1	264.5±212.3	342.7±247.8
	After	103.4±91.4	70.2±43.2	139.0±128.0	139.3±103.4
	t value	1.305	2.366	4.65	9.597
	P value	0.24	0.077	0.000	0.000
AST(IU/L)	Before	226.7±177.6	205.6±109.0	309.8±365.0	364.1±334.1
	After	93.7±95.2	51.0±44.9	91.8±105.0	73.7±76.4
	t value	1.691	3.611	4.323	9.029
	P value	0.142	0.023	0.000	0.000
GGT(IU/L)	Before	211.1±170.7	475.8±463.6	445.5±274.6	514.2±399.6
	After	163.3±118.1	163.3±118.1	313.9±190.2	332.3±2637
	t value	2.245	2.377	5.122	10.383
	P value	0.066	0.076	0.000	0.000

Item	Before or after treatment	Treatment
Item	Before or after treatment	ENBD(n=31)	ERBD(n=108)
Amylase (IU/L)	Before	70.4±74.4	115.7±165.8
	After	104.9±71.2	114.7±153.8
	t value	-1.809	0.037
	P value	0.088	0.971

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