本文關(guān)鍵詞： 急性梗阻化膿性膽管炎 病原菌 內(nèi)鏡 肝臟功能　出處：《中華醫(yī)院感染學(xué)雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的探討急性梗阻化膿性膽管炎(AOSC)的內(nèi)鏡治療及細(xì)菌感染對(duì)預(yù)后的影響,為臨床合理指導(dǎo)AOSC患者的內(nèi)鏡下治療提供更多循證醫(yī)學(xué)證據(jù)。方法選取2013年1月-2016年10月醫(yī)院收治的AOSC患者310例;依據(jù)手術(shù)方式不同,分為內(nèi)鏡組140例和對(duì)照組170例;內(nèi)鏡組患者行逆行胰膽管造影(ERCP)配合內(nèi)鏡鼻膽管引流術(shù)(ENBD);對(duì)照組患者行傳統(tǒng)手術(shù)治療(膽管切開(kāi)減壓+T管引流術(shù)),比較兩組患者的臨床療效,細(xì)菌感染的病原學(xué)分布特點(diǎn)及對(duì)預(yù)后的影響。結(jié)果兩組患者在性別、年齡、發(fā)病至就診時(shí)間和術(shù)前肝功指標(biāo)上比較差異均無(wú)統(tǒng)計(jì)學(xué)意義;內(nèi)鏡組患者的治愈率為94.28%,顯著高于對(duì)照組的87.64%;內(nèi)鏡組患者黃疸減輕時(shí)間、腹痛緩解時(shí)間、引流管拔除時(shí)間及總住院時(shí)間均短于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與術(shù)前相比,術(shù)后兩組患者肝功丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、血清總膽紅素(TBIL)明顯降低,白蛋白(ALB)水平顯著升高(P0.05);炎癥因子超敏C-反應(yīng)蛋白(hs-CRP)水平顯著下降(P0.05);且術(shù)后內(nèi)鏡組ALT、AST和hs-CRP水平與對(duì)照組比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論內(nèi)鏡治療AOSC患者的療效優(yōu)于傳統(tǒng)手術(shù)治療,合并細(xì)菌感染的病原菌分布特點(diǎn)并非影響患者手術(shù)方式及預(yù)后的主要因素。
[Abstract]:Objective to investigate the endoscopic treatment of acute obstructive suppurative cholangitis (AOSC) and the effect of bacterial infection on prognosis. Methods 310 patients with AOSC were selected from January 2013 to October 2016, who were divided into endoscopic group (n = 140) and control group (n = 170). The patients in the endoscopic group were treated with retrograde cholangiopancreatography (ERCP) combined with endoscopic nasobiliary drainage (ENBDD), while the patients in the control group were treated with traditional surgical treatment (cholangiotomy and decompression of T-tube drainage), and the clinical efficacy of the two groups was compared. Results there was no significant difference in sex, age, time from onset to visit and preoperative liver function between the two groups. The cure rate of the patients in the endoscopic group was 94.28, which was significantly higher than that in the control group (87.64). The time for relieving jaundice, relieving abdominal pain, extubation of drainage tube and total hospital stay in the endoscopic group were shorter than those in the control group (P 0.05). The levels of alt, AST, TBILs and TBILs were significantly decreased in the two groups after operation. The levels of Alb and hs-CRP in the endoscopic group were significantly higher than those in the control group, and the levels of inflammatory factor hypersensitive C-reactive protein hs-CRP were significantly decreased in the endoscopy group, and compared with the control group, the levels of alt and hs-CRP in the endoscopic group were significantly lower than those in the control group. Conclusion Endoscopic treatment of AOSC patients is more effective than traditional surgical treatment, and the distribution of pathogenic bacteria associated with bacterial infection is not the main factor affecting the operation mode and prognosis of the patients.
【作者單位】： 溫嶺市第一人民醫(yī)院消化內(nèi)科;溫嶺市第一人民醫(yī)院肝膽外科;
【基金】：浙江省醫(yī)學(xué)會(huì)臨床科研基金資助項(xiàng)目(2011ZYC-A02)
【分類號(hào)】：R657.4

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