经皮经肝胆管穿刺引流术治疗急性胆道感染患者疗效研究*

doi:10.3969/j.issn.1672-5069.2026.02.039

摘要/Abstract

摘要： 目的研究经皮经肝胆管穿刺引流术(PTCD)治疗急性胆道感染患者的疗效。方法 2021年1月～2024年12月我院诊治的83例急性胆道感染患者,均接受PTCD和二期手术治疗。采用ELISA法检测血清白细胞介素-6(IL-6),常规检测降钙素原(PCT)水平。结果 83例急性胆道感染患者接受PTCD治疗操作成功77例(92.8%),在77例成功引流患者,42例(54.5%)于感染控制后接受择期胆囊切除术或胆总管探查术,手术成功,术后平均住院日为(7.5±1.8)d,术后恢复良好。35例因高龄、合并严重基础疾病或患者自身意愿未行进一步手术,采用保守治疗,随访3～18个月(中位9个月),其中5例(14.3%)因胆道再梗阻复发感染,经再次PTCD或ERCP处理后缓解;另6例未有效引流,经内科药物治疗后2～5个月痊愈;77例成功引流患者术前白细胞计数、中性粒细胞百分比、血清总胆红素、IL-6和PCT水平分别为(24.7±5.4)×10⁹/L、(83.4±12.6)%、(110.2±23.1)μmol/L、(97.6±15.8)ng/L和(12.1±0.8)μg/L,治疗后分别降为(7.4±2.6)×10⁹/L、(65.3±10.7)%、(16.3±13.4)μmol/L、(27.5±7.7)ng/L和(0.1±0.0)μg/L,差异显著(P<0.05)。结论采取PTCD紧急处理急性胆道感染患者,再二期手术临床疗效确切,及时进行病原菌分离,有助于抗生素选择。

关键词: 急性胆道感染, 经皮肝穿刺胆道引流术, 病原菌, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) in the treatment of patients with acute biliary tract infections (ABTI). Methods A retrospective analysis was conducted on the clinical data of 83 patients with ABTI who underwent PTCD management in our hospital between January 2021 and December 2024, and patients received phase two surgery for eradication. Serum procalcitonin (PCT) level was routinely detected and interleukin-6 (IL-6) level was assayed by ELISA. Results 77 cases (92.8%) obtained successful PTCD out of the 83 patients with ABTI in our series, and 42 cases of them (54.5%)recovered after phase two operation, with hospital stay of(7.5±1.8)d; no further operation performed in another 35 cases because of elderly ages, concomitant diseases, and they recovered by supporting measures after 3 to 18 months; PTCD failed in 6 cases, and they recovered after 2 to 5 months of supporting management and antibiotic therapy; at admission, white blood cell count, percentage of neutrophil, total serum bilirubin, IL-6 and PCT levels in 77 patients with successful PTCD were(24.7±5.4)×10⁹/L, (83.4±12.6)%,(110.2±23.1)μmol/L, (97.6±15.8)ng/L and (12.1±0.8)μg/L, and they turned to (7.4±2.6)×10⁹/L, (65.3±10.7)%, (16.3±13.4)μmol/L, (27.5±7.7)ng/L and (0.1±0.0)μg/L after recovery (P<0.05). Conclusion PTCD might be a bridge measure as emergent management to phase two surgery for patients with ABTI, which warrants further clinical investigation.

Key words: Acute biliary tract infection, Percutaneous transhepatic cholangial drainage, Pathogenic bacteria, Therapy

万伟, 章雨晨, 沈宇. 经皮经肝胆管穿刺引流术治疗急性胆道感染患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 317-320.

Wan Wei, Zhang Yuchen, Shen Yu. Efficacy of PTCD in dealing with patients with acute biliary tract infections[J]. Journal of Practical Hepatology, 2026, 29(2): 317-320.

参考文献

[1] Chen S, Shi J, Chen M, et al. Characteristics of and risk factors forbiliary pathogen infection in patients with acute pancreatitis. BMC Microbiol, 2021, 21(1):269.
[2] Jaan A, Zubair A, Farooq U, et al. Impact of frailty on outcomes and biliary drainage strategies in acute cholangitis: A retrospective cohort analysis. Clin Res Hepatol Gastroenterol, 2025, 49(4):102568.
[3] Novak A, Acharya A, Beer S, et al. Pilot feasibility study to determine the utility of direct access and quantitative magnetic resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or ductal gallstone presentations. BMC Gastroenterol, 2025, 25(1):72.
[4] Becker JN, Ginn EA, Bandera B, et al. Chronic gallstone ileus presenting as acute small bowelobstruction: A case study. Am J Case Rep, 2024, 25:e945343.
[5] Tanikawa T, Miyake K, Kawada M, et al. Optimal timing of precut sphincterotomy to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult biliary cannulation: A retrospective study. DEN Open, 2025, 6(1):e70138.
[6] Inoue T, Kitano R, Kitada T, et al. Transpancreatic precut sphincterotomy with a novel highly rotatable sphincterotome in balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. Endoscopy, 2025, 57(S1):E363-E364.
[7] Lu Y, Lv X, He S. Dual-frequency intraductal ultrasonography: a breakthrough in biliopancreatic imaging during endoscopic retrograde cholangiopancreatography. Endoscopy, 2025, 57(S1):E355-E356.
[8] Zhou H, Liu C, Yu X, et al. Efficacy and safety of endoscopic nasobiliary drainage versus percutaneous transhepatic cholangial drainage in the treatment of advanced hilar cholangiocarcinoma: a systematic review and meta-analysis. BMC Gastroenterol, 2024, 24(1):302.
[9] Zhang XL, Sun JH, Wu Y, et al. Therapeutic outcomes of early and delayed endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage in patients with obstructive severe acute biliary pancreatitis. J Clin Transl Res, 2023, 9(3):160-167.
[10] Lee S, Qasim A, Alemam A, et al. Extended-spectrum beta-lactamase Escherichia coli-associated acute cholangitis: Uncommon patient characteristics and clinical implications. Cureus, 2024, 16(2):e54533.
[11] Zhang P, Jiang N, Xu L, et al. Clostridium perfringens and Escherichia coli bacteremia in a patient with acute obstructive suppurative cholangitis: A case report and review of the literature. Am J Case Rep, 2022, 23:e936329.
[12] 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021年版). 中华外科杂志, 2021, 59(6):422-429.
[13] 吴自友, 吴向嵩, 姚文衍, 等. 急性胆道感染患者胆汁病原菌分布及耐药率变迁. 中华外科杂志, 2021, 59(1):24-31.
[14] Huang S, Zhou Y, Liang Y, et al. Machine-learning-derived online prediction models of outcomes for patients with cholelithiasis-induced acute cholangitis: development and validation in two retrospective cohorts. E Clin Med, 2024, 76:102820.
[15] Bhutiani N, Brown AN, Davis EG, et al. Correlation of biliarycolic in the absence of cholelithiasis with pancreaticobiliary obstruction. Am Surg, 2018, 84(6):868-874.
[16] Zhang J, Ma M, Tian J, et al. The efficacy of laparoscopic cholecystectomy vs. non-invasive gallstone dissolution to manage cholelithiasis: clinical outcomes and quality of life. Minerva Surg, 2025, 80(2):131-137.
[17] Lyu Y, Tong S, Huang W, et al. Observational, causal relationship and shared genetic basis between cholelithiasis and gastroesophageal reflux disease: evidence from a cohort study and comprehensive genetic analysis. Gigascience, 2025, 14:giaf023.
[18] Pan SY, Zhou CB, Deng JW, et al. The effects of pks⁺ Escherichia coli and bile acid in colorectal tumorigenesis among people with cholelithiasis or cholecystectomy. J Gastroenterol Hepatol, 2024, 39(5):868-879.
[19] Manolis EN, Filippou DK, Papadopoulos VP, et al. The culture site of the gallbladder affects recovery of bacteria in symptomatic cholelithiasis. J Gastrointestin Liver Dis, 2008, 17(2):179-182.
[20] 高青豹, 李文刚, 林明强, 等. 经内镜下逆行胰胆管造影术治疗急性梗阻性化脓性胆管炎患者疗效及感染病原菌调查. 实用肝脏病杂志, 2019, 22(5):740-743.

经皮经肝胆管穿刺引流术治疗急性胆道感染患者疗效研究^*

Efficacy of PTCD in dealing with patients with acute biliary tract infections

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