经皮经肝胆囊穿刺引流治疗急性胆源性胰腺炎疗效的研究

doi:10.16139/j.1007-9610.2023.03.014

摘要/Abstract

摘要：

目的：回顾性分析经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage，PTGBD)在急性胆源性胰腺炎(acute biliary pancreatitis, ABP)病人治疗中的临床疗效。方法：纳入2014年1月至2021年11月我院普通外科诊治的ABP病人244例。研究组76例，经PTGBD治疗，41例症状缓解后行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)治疗；对照组168例，均未行PTGBD治疗，其中ERCP治疗49例，保守治疗119例。比较两组ERCP治疗后胰腺炎(post-ERCP pancreatitis, PEP)发生率、胆囊切除术以及同时胆道引流的术后不良事件发生率。结果：研究组PEP发生率明显较对照组低[26.8%(11/41)比46.9%(23/49)，P=0.008]。两组治疗后期(研究组73例和对照组152例)行胆囊切除术或胆囊切除胆道引流术。研究组手术时间较对照组短[(76.3±28.3) min比(121.6±34.9) min,P=0.011]，术中出血量较少[(65.7±27.6) mL比(99.2±60.3) mL，P=0.028], 术后腹腔引流时间缩短[(3.6± 2.5) d比(8.9±4.9) d，P=0.016]。研究组术后脓毒症[2.7%(2例)比5.3%(8例)，P=0.003]、二次手术[1.4%(1例)比3.9%(6例)，P<0.001]、术后转重症监护室发生率[4.1%(3例)比7.2%(11例)，P=0.028]以及死亡率[0比1.3%(2例)，P<0.001]均低于对照组。结论：PTGBD治疗ABP简单有效，符合损伤控制治疗理念，值得临床推广。

关键词: 急性胆源性胰腺炎, 经皮经肝胆囊穿刺引流, 不良事件

Abstract:

Objective To evaluate retrospectively the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) in the patients with acute biliary pancreatitis (ABP). Methods A total of 244 patients with ABP recei-ving treatment in our department from January 2014 to November 2021 were included in this study. There were 76 cases in study group using PTGBD treatment, among them, 41 cases with performed endoscopic retrograde cholangiopancreatography (ERCP) after symptoms remission, and 168 cases without PTGBD in control group with 49 cases using ERCP and 119 cases with conservative treatment. The rate of post-ERCP pancreatitis (PEP) and postoperative adverse events were compared between two groups. Results The rate of PEP was significantly lower in study group (11/41) than in control group (23/49), 26.8% vs.46.9%, P=0.008. The patients in both groups were performed cholecystectomy or cholecystectomy with bile duct drainage in late stage (73 cases in study group and 152 cases in control group). The shorter operative time [(76.3±28.3) min vs.(121.6±34.9) min, P=0.011], less intraoperative blood loss [(65.7±27.6) mL vs. (99.2±60.3) mL, P=0.028], shorter abdominal drainage duration [(3.6±2.5) d vs. (8.9±4.9) d, P=0.016] in study group than in control group. The rate of postoperative sepsis [2.7% (2 cases) vs. 5.3% (8 cases), P=0.003], rate of reoperation [1.4%(1 case) vs. 3.9%(6 cases), P<0.001], rate of admission to intensive care unit [4.1%(3 cases) vs. 7.2%(11 cases), P=0.028], and mortality [0 vs. 1.3% (2 cases), P<0.001] in study group were lower than those in control group. Conclusions PTGBD could be simple and effective in the treatment of ABP and consistent with treatment of damage control surgery which should be worthy clinical application.

Key words: Acute biliary pancreatitis, Percutaneous transhepatic gallbladder drainage, Adverse event

中图分类号:

张震, 韩金岩, 于晓鹏, 邓天麟, 吴晓东, 吴硕东. 经皮经肝胆囊穿刺引流治疗急性胆源性胰腺炎疗效的研究[J]. 外科理论与实践, 2023, 28(03): 260-266.

ZHANG Zhen, HAN Jinyan, YU Xiaopeng, DENG Tianlin, WU Xiaodong, WU Shuodong. Study on effects of percutaneous transhepatic gallbladder drainage in treatment of acute biliary pancreatitis[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 260-266.

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