急性梗阻性化膿性膽管炎（AOSC）的治療方法選擇的臨床研究
發(fā)布時(shí)間：2018-10-09 09:57
【摘要】：目的： 比較膽管切開減壓、T管引流術(shù)；ERCP+EST+ENBD術(shù)；PTCD術(shù)對急性梗阻性化膿性膽管炎(AOSC)患者的治療效果,為臨床治療AOSC手術(shù)方式選擇提供依據(jù)。 方法： 收集昆明醫(yī)科大學(xué)第二附屬醫(yī)院肝膽外二科2012年1月-2012年12月間56例急性梗阻性化膿性膽管炎患者的臨床資料。其中：1、膽管切開減壓、T管引流術(shù)者21例(A組)；2、ERCP+EST+ENBD者13例(B組)：3、PTCD術(shù)者22例(C組)。術(shù)前及術(shù)后均進(jìn)行控制感染,抗休克,糾正水、電解質(zhì)、酸堿平衡紊亂,積極治療原有合并疾病。分析比較各組手術(shù)方式患者術(shù)前24小時(shí)、術(shù)后24小時(shí)、72小時(shí)、1周、2周時(shí)的總膽紅素、丙氨酸氨基轉(zhuǎn)移酶(ALT)、感染性休克癥狀、神經(jīng)系統(tǒng)受抑制癥狀、并發(fā)癥率、死亡率、住院天數(shù)。應(yīng)用SPSS17.0版軟件,數(shù)據(jù)采用x±s表示,各組計(jì)量資料間比較采用t檢驗(yàn),以P0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.術(shù)后72h內(nèi),膽管切開減壓、T管引流術(shù)組(A組)總膽紅素、丙氨酸氨基轉(zhuǎn)移酶(ALT)減退效果較ERCP+EST+ENBD術(shù)組(B組)更好,術(shù)后1周時(shí)兩組比較無差異；24h內(nèi)A組感染性休克和神經(jīng)系統(tǒng)受抑制癥狀較B組組緩解明顯,但術(shù)后72h后,A組、B組比較無差異；A組死亡4例；A組并發(fā)癥發(fā)生率和死亡率明顯高于B組；A組住院天數(shù)明顯較B組短。 2.術(shù)后1周內(nèi),膽管切開減壓、T管引流術(shù)組(A組)總膽紅素、丙氨酸氨基轉(zhuǎn)移酶(ALT)減退效果較PTCD術(shù)組(C組)更好,術(shù)后2周兩組比較無差異；24h內(nèi)A組感染性休克和神經(jīng)系統(tǒng)受抑制癥狀較C組緩解更明顯,但術(shù)后72h后,A組、B組比較無差異;A組并發(fā)癥發(fā)生率和死亡率明顯高于C組；A組住院天數(shù)明顯較C組短。 3.ERCP+EST+ENBD術(shù)組(B組)與PTCD組(C組)比較,在總膽紅素減退、丙氨酸氨基轉(zhuǎn)移酶降低、感染性休克及神經(jīng)系統(tǒng)受抑制癥狀持續(xù)緩解方面無統(tǒng)計(jì)學(xué)意義：術(shù)后并發(fā)癥、死亡率也無統(tǒng)計(jì)學(xué)意義：B組住院天數(shù)較C組短。 結(jié)論： 1.PTCD術(shù)能充分引流膽汁,解除膽道壓力,解除膽道梗阻效果理想。而且此手術(shù)創(chuàng)傷小、操作較簡便、手術(shù)時(shí)間短、無需全身麻醉,術(shù)后并發(fā)癥、死亡率較低等。符合損傷控制外科(DCS)的原則。緩解了AOSC患者危機(jī)癥狀,為二次去除病因的徹底手術(shù)創(chuàng)造條件。PTCD術(shù)適用癥：肝內(nèi)外膽管結(jié)石并引起膽管擴(kuò)張的AOSC患者。 2. ERCP+EST+ENBD術(shù)能解除部分AOSC患者的膽總管下端的梗阻,能較充分引流膽汁,降低膽管壓力,緩解AOSC患者的危急癥狀。手術(shù)創(chuàng)傷小,術(shù)后恢復(fù)快。適用癥：膽總管下端結(jié)石引起梗阻的AOSC患者。禁忌癥：患者年齡較大,感染性休克及精神癥狀較重,有心、腦、血管、肺部等并發(fā)疾病。 3.膽道切開減壓、T管引流術(shù)也能充分引流膽汁,立即解除膽道壓力,同時(shí)可在直視下發(fā)現(xiàn)并解除部分梗阻病因。但因手術(shù)創(chuàng)傷較大,形成二次打擊,且麻醉對呼吸、血液循環(huán)影響導(dǎo)致患者死亡率及術(shù)后并發(fā)癥發(fā)生率最高。適用癥：無法行ERCP+EST+ENBD術(shù)治療,PTCD術(shù)穿刺失敗的AOSC患者。禁忌癥：患者年齡較大,感染性休克及精神癥狀較重,有心、腦、血管、肺部等并發(fā)疾病。
[Abstract]:Purpose: Comparison of bile duct incision decompression, T-tube drainage; ERCP + EST + ENBD; treatment effect of PTCD for patients with acute obstructive purulent cholangitis (AOSC). Basis. Methods: From January 2012 to December 2012, 56 cases of acute obstructive purulent cholangitis were collected from the second Affiliated Hospital of Kunming Medical University from January 2012 to December 2012. Among them, 21 cases (group A), 2 ERCP + EST + ENBD 13 cases (group B): 3, PTCD operation. 22 patients (group C) underwent control infection, anti-shock, correction of water, electrolyte and acid-base balance disorder before and after operation. The total bilirubin, alanine aminotransferase (ALT), septic shock symptom, nervous system inhibited symptom and complication rate were analyzed in 24 hours, 24 hours, 72 hours, 1 week and 2 weeks before operation. Mortality and hospitalization days. The software of SPSS1.7. 0 was used. The data was expressed by x/ s, and t-test was used for each group of measurement data to P0. 0. 5 is available Results: 1. After operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of ERCP + EST + ENBD group (group B). There was no difference between the two groups at 1 week after operation, but there was no difference in group A and group B after 72h after operation, but there was no difference in group A and group B after operation, 4 cases died in group A, and the incidence and death rate of complication in group A were significantly higher than that in group B. In group A, the number of days of hospitalization in group A was significantly shorter than that in group B. In 1 week after operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of PTCD group (group A). In group C, there was no difference between group A and group B after 2 weeks after operation, but there was no difference between group A and group B after 72h after operation, but there was no difference in group A and group B after operation. Compared with group C, the number of days in group A was significantly shorter than that in group C. 3. ERCP + EST + ENBD group (group B) was compared with PTCD group (group C). Learning significance: Postoperative complications, death the rate of death also No statistical significance: The number of days of hospitalization in group B was shorter than that in group C. Conclusion: 1. PTCD The operation is small, and the operation is simple and convenient. and the operation time is short, the whole body anesthesia is not needed, and the operation time is short, It has low mortality and lower mortality. It is consistent with the principle of injury control surgery (DCS). The symptoms of crisis in patients with OSC provide conditions for the complete operation of secondary removal of the cause. PTCD Intraoperative treatment: an AOSC patient with extrahepatic bile duct stones and dilatation of the bile duct. ERCP + EST + ENBD can relieve obstruction of the lower end of the common bile duct of some AOSC patients, can fully drain the bile and reduce the gall bladder Tube pressure to relieve emergency symptoms of AOSC patients. Small surgical trauma Post-operative recovery is fast. Applicable: AOSC patients with obstruction due to common bile duct stones. Contraindications: Patients are older "Infectious shock and mental symptoms are heavier, and complicated diseases such as brain, brain, blood vessel, lung, etc. 3. The decompression and drainage of T-tube can also be sufficient." Drainage of bile can immediately relieve the pressure of biliary tract, and can find and relieve the cause of partial obstruction at the same time. and the effect of anesthesia on respiration and blood circulation leads to the highest incidence of mortality and postoperative complications in patients. Treatment with RCP + EST + ENBD, AOSC patients with failed PTCD puncture. Contraindications: Patient Yea
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R657.41
本文編號(hào)：2258918
[Abstract]:Purpose: Comparison of bile duct incision decompression, T-tube drainage; ERCP + EST + ENBD; treatment effect of PTCD for patients with acute obstructive purulent cholangitis (AOSC). Basis. Methods: From January 2012 to December 2012, 56 cases of acute obstructive purulent cholangitis were collected from the second Affiliated Hospital of Kunming Medical University from January 2012 to December 2012. Among them, 21 cases (group A), 2 ERCP + EST + ENBD 13 cases (group B): 3, PTCD operation. 22 patients (group C) underwent control infection, anti-shock, correction of water, electrolyte and acid-base balance disorder before and after operation. The total bilirubin, alanine aminotransferase (ALT), septic shock symptom, nervous system inhibited symptom and complication rate were analyzed in 24 hours, 24 hours, 72 hours, 1 week and 2 weeks before operation. Mortality and hospitalization days. The software of SPSS1.7. 0 was used. The data was expressed by x/ s, and t-test was used for each group of measurement data to P0. 0. 5 is available Results: 1. After operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of ERCP + EST + ENBD group (group B). There was no difference between the two groups at 1 week after operation, but there was no difference in group A and group B after 72h after operation, but there was no difference in group A and group B after operation, 4 cases died in group A, and the incidence and death rate of complication in group A were significantly higher than that in group B. In group A, the number of days of hospitalization in group A was significantly shorter than that in group B. In 1 week after operation, the total bilirubin and alanine aminotransferase (ALT) in T-tube drainage group (group A) were lower than that of PTCD group (group A). In group C, there was no difference between group A and group B after 2 weeks after operation, but there was no difference between group A and group B after 72h after operation, but there was no difference in group A and group B after operation. Compared with group C, the number of days in group A was significantly shorter than that in group C. 3. ERCP + EST + ENBD group (group B) was compared with PTCD group (group C). Learning significance: Postoperative complications, death the rate of death also No statistical significance: The number of days of hospitalization in group B was shorter than that in group C. Conclusion: 1. PTCD The operation is small, and the operation is simple and convenient. and the operation time is short, the whole body anesthesia is not needed, and the operation time is short, It has low mortality and lower mortality. It is consistent with the principle of injury control surgery (DCS). The symptoms of crisis in patients with OSC provide conditions for the complete operation of secondary removal of the cause. PTCD Intraoperative treatment: an AOSC patient with extrahepatic bile duct stones and dilatation of the bile duct. ERCP + EST + ENBD can relieve obstruction of the lower end of the common bile duct of some AOSC patients, can fully drain the bile and reduce the gall bladder Tube pressure to relieve emergency symptoms of AOSC patients. Small surgical trauma Post-operative recovery is fast. Applicable: AOSC patients with obstruction due to common bile duct stones. Contraindications: Patients are older "Infectious shock and mental symptoms are heavier, and complicated diseases such as brain, brain, blood vessel, lung, etc. 3. The decompression and drainage of T-tube can also be sufficient." Drainage of bile can immediately relieve the pressure of biliary tract, and can find and relieve the cause of partial obstruction at the same time. and the effect of anesthesia on respiration and blood circulation leads to the highest incidence of mortality and postoperative complications in patients. Treatment with RCP + EST + ENBD, AOSC patients with failed PTCD puncture. Contraindications: Patient Yea
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R657.41
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