ERCP治疗急性梗阻性化脓性胆管炎患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.02.033

摘要/Abstract

摘要： 目的探讨内镜下逆行胰胆管造影术(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法 2020年1月～2023年1月我院收治的AOSC患者103例, 其中观察组58例接受ERCP治疗, 对照组45例接受开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度, 采用ELISA法检测血清白细胞介素(IL)-6、IL-1、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP)水平。结果观察组术中出血量、手术时间、术后3 d VAS评分和术后住院日分别为(30.7±4.6)mL、(74.3±8.8)min、(3.1±0.8)分和(7.2±1.4)d, 均显著短于或少于对照组【分别为(85.4±10.2)mL、(117.6±12.5)min、(4.9±1.1)分和(13.3±3.7)d, P＜0.05】;在术后5 d, 观察组血清ALT和GGT水平分别为(48.2±4.1)U/L和(163.9±17.2)U/L, 均显著低于对照组【分别为(66.9±5.3)U/L和(189.6±21.5)U/L, P＜0.05】;观察组血清IL-6、IL-1、TNF-α和CRP水平分别为(82.6±8.3)ng/L、(20.9±4.0)ng/L、(16.2±3.5)ng/L和(18.1±2.2)mg/L, 均显著低于对照组【分别为(100.7±11.2)ng/L、(32.7±5.3)ng/L、(23.6±4.3)ng/L和(32.9±4.8)mg/L, P＜0.05】; 观察组并发症发生率为5.1%, 显著低于对照组的17.8%(P＜0.05)。结论采用ERCP治疗AOSC患者效果好, 术后恢复快, 并发症发生率低, 值得临床应用。

关键词: 急性梗阻性化脓性胆管炎, 内镜下逆行胰胆管造影术, 细胞因子, 治疗

Abstract: Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and open surgery in the treatment of patients with acute obstructive suppurative cholangitis (AOSC). Methods A total of 103 patients with AOSC were encountered in our hospital between January 2020 and January 2023, and 58 patients in observation group received ERCP therapy and 45 patients in control group received open laparotomy. The pain was evaluated by visual analogue scale (VAS), and serum interleukin(IL)-6, IL-1, tumor necrosis factor (TNF)-α and C-reactive protein (CRP) levels were detected by ELISA. Results The intraoperative blood loss, operation time, VAS score at day three after surgery and hospitalization stay in the observation group were(30.7±4.6)mL, (74.3±8.8)min, (3.1±0.8) and (7.2±1.4)d, all significantly less or shorter than in the control; at day five after surgery, serum ALT and GGT levels in the observation group were (48.2±4.1)U/L and (163.9±17.2)U/L, both significantly lower than in the control; serum IL-6, IL-1, TNF-α and CRP levels in the observation were (82.6±8.3)ng/L, (20.9±4.0)ng/L, (16.2±3.5)ng/L and (18.1±2.2)mg/L, all significantly lower than in the control; the incidence of post-operational complications in the observation group was significantly lower than that in the control group (5.1% vs. 17.8%, P<0.05). Conclusion The ERCP therapy was successfully completed in our series, and it could deal emergently or urgently with patients with AOSC, which warrants further clinical investigation.

Key words: Acute obstructive suppurative cholangitis, Endoscopic retrograde cholangiopancreatography, Cytokines, Therapy

何晓非, 陈杰, 罗国松, 陆世峰. ERCP治疗急性梗阻性化脓性胆管炎患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 291-294.

He Xiaofei, Chen Jie, Luo Guosong, et al.. Comparison of ERCP and open surgery in the treatment of patients with acute obstructive suppurative cholangitis: A single center study[J]. Journal of Practical Hepatology, 2024, 27(2): 291-294.

参考文献

[1] 郭强, 钟锴, 蒋铁民, 等. 经内镜胆道内支架放置术在老年急性梗阻性化脓性胆管炎中的应用价值. 中华消化内镜杂志, 2022, 39(8):645-649.
[2] Yamada K, Shinoura S. Unusual biliary gem: cause of acute obstructive suppurative cholangitis and pancreatitis in a patient with billroth II anastomosis. Ann Acad Med Singap, 2022, 51(3):196-197.
[3] Zhai LL, Xiang F, Wang W, et al. Atypical presentations of coronavirus disease 2019 in a patient with acute obstructive suppurative cholangitis. Clin Res Hepatol Gastroenterol, 2020, 44(6):e135-e140.
[4] Zhu Z, Yu J, Lin W, et al. Molecular hydrogen accelerates the reversal of acute obstructive cholangitiscinduced liver dysfunction by restoring gap and tight junctions. Mol Med Rep, 2019, 19(6):5177-5184.
[5] 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.
[6] Pécsi D, Gódi S, Hegyi P, et al. ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis - analysis of theHungarian ERCP registry data. Pancreatology, 2021, 21(1):59-63.
[7] Iqbal U, Khara HS, Hu Y, et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc, 2020, 91(4):753-760.
[8] 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.
[9] Zhang HY, Lu ZQ, Wang GX, et al. Presepsin as a biomarker for risk stratification for acute cholangitis in emergency department: a single-center study. World J Clin Cases, 2021, 9(32):9857-9868.
[10] 蔡锋, 朱运海, 赵杰, 等. 急性梗阻性化脓性胆管炎与糖类抗原199和血小板计数变化的关系. 中华实验外科杂志, 2021, 38(8):1563-1566.
[11] Kasparian K, Christou CD, Petidis K, et al. Short vs long-course antibiotic therapy in adults with acute cholangitis: A systematic review, meta-analysis, and evidence quality assessment. World J Gastroenterol, 2023, 29(19):3027-3039.
[12] Kaur M, Chandel K, Reddy P, et al. Neutrophil-lymphocyte ratio predicts clinical response to percutaneous transhepatic biliary drainage in acute cholangitis. J Clin Exp Hepatol, 2023, 13(3):390-396.
[13] Takahashi K, Ohyama H, Takiguchi Y, et al. Feasibility of biliary drainage using a novel integrated biliary stent and nasobiliary drainage catheter system for acute cholangitis. Cureus, 2023, 15(4):e37477.
[14] Zhang HY, Xiao HL, Wang GX, et al. Predictive value of presepsin and acylcarnitines for severity and biliary drainage in acute cholangitis. World J Gastroenterol, 2023, 29(16):2502-2514.
[15] Hallensleben ND, Stassen PMC, Schepers NJ, et al. Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): a multicentre prospective study. Gut, 2023, 72(8):1534-1542.
[16] Qureshi LA, Alzanbagi A, Tashkandi A, et al. Retrospective analysis of characteristics, indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral center in Saudi Arabia. Cureus, 2023, 15(3):e36794.
[17] Weissman S, Sharma S, Ehrlich D, et al. The role and timing of endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis without cholangitis: A nationwide analysis. J Hepatobiliary Pancreat Sci, 2023, 30(6):767-776.
[18] Lyu Y, Wang B, Ye S, et al. Impact of the timing of endoscopic retrograde cholangiopancreatography for the treatment of acute cholangitis: a meta-analysis and systematic review. Surg Laparosc Endosc Percutan Tech, 2022, 32(6):764-769.
[19] Huang YC, Wu CH, Lee MH, et al. Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity. World J Gastroenterol, 2022, 28(38):5602-5613.
[20] 李蔚, 王锡斌, 崔卫东, 等. 超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析. 实用肝脏病杂志, 2020, 23(3):447-450.
[21] Al-Yahri O, Al-Zoubi RM, Elhuda AA, et al. Diagnostic inflammation biomarkers for prediction of 30-day mortality rate in acute cholangitis. Int J Surg Protoc, 2022, 26(1):14-21.
[22] Farooq U, Gondal AB, Franco D, et al. Validation of Tokyo guidelines 2018 for safety and mortality benefit from urgent ERCP in acute cholangitis across different age groups. J Hepatobiliary Pancreat Sci, 2023, 30(6):737-744.

ERCP治疗急性梗阻性化脓性胆管炎患者疗效研究^*

Comparison of ERCP and open surgery in the treatment of patients with acute obstructive suppurative cholangitis: A single center study

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