【摘要】：目的:探討在內(nèi)鏡下鼻膽管引流術(shù)(ENBD)或經(jīng)皮經(jīng)肝穿刺膽道引流術(shù)(PTCD)在急性重癥膽管炎(ACST)中的應(yīng)用及中藥清熱利膽顆粒(QRLD)的干預(yù)作用;方法:選取2013年1月至2017年1月我科收治的行ENBD或PTCD膽道減壓引流的ACST患者為研究對(duì)象,依據(jù)1983年全國(guó)膽道外科疾病專題討論會(huì),所有患者均符合急性重癥膽管炎的診斷標(biāo)準(zhǔn)。依據(jù)是否應(yīng)用院內(nèi)制劑清熱利膽顆粒(QRLD)將患者分為四組:ENBD組患者單純行內(nèi)鏡下鼻膽管引流治療;ENBD聯(lián)合QRLD組患者行ENBD后予以中藥清熱利膽顆粒輔助治療;PTCD組患者單純行PTCD引流治療;PTCD聯(lián)合QRLD組患者行PTCD引流后予以中藥清熱利膽顆粒輔助治療。對(duì)四組患者術(shù)前與術(shù)后一周炎癥水平(白細(xì)胞總數(shù)、粒細(xì)胞百分比)、黃疸水平(總膽紅素)及肝功能(ALT、AST)、術(shù)后引流量、體溫等指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析,評(píng)估清熱利膽顆粒對(duì)ENBD或PTCD引流的輔助作用;對(duì)各組患者術(shù)后總有效率及死亡率、并發(fā)癥發(fā)生率進(jìn)行統(tǒng)計(jì)學(xué)分析,觀察清熱利膽顆粒輔助治療ACST的療效。結(jié)果:2013年1月至2017年1月我科共收治的并行ENBD或PTCD患者共96例,所有患者均符合急性重癥膽管炎(ACST)的診斷標(biāo)準(zhǔn),依據(jù)其嚴(yán)重程度可分為:Ⅰ級(jí)52例、Ⅱ級(jí)22例、Ⅲ級(jí)6例、Ⅳ級(jí)16例。單純行膽道減壓引流術(shù)61例,包括ENBD治療33例和PTCD治療28例;其余35例患者術(shù)后予以口服清熱利膽顆粒,包括ENBD治療聯(lián)合清熱利膽顆粒治療19例和PTCD聯(lián)合清熱利膽顆粒治療16例。統(tǒng)計(jì)顯示,四組患者年齡、性別、發(fā)病原因、伴發(fā)疾病、合并癥和既往膽道手術(shù)史等一般狀況沒(méi)有顯著差別(P0.05);四組患者術(shù)后一周炎癥水平(白細(xì)胞總數(shù)、粒細(xì)胞百分比)、黃疸水平(總膽紅素)及肝功能(ALT、AST)等指標(biāo)均比術(shù)前明顯好轉(zhuǎn)(P0.05),對(duì)應(yīng)兩組間比較,中藥聯(lián)合觀察組患者炎癥水平和黃疸水平下降程度比單純ENBD或PTCD治療更低(P0.05);術(shù)后總有效率及死亡率、并發(fā)癥發(fā)生率等與單純引流組相比,中藥聯(lián)合組患者總有效率明顯提高且并發(fā)癥發(fā)生率更低(P0.05)。結(jié)論:急性重癥膽管炎發(fā)病急驟、病情進(jìn)展迅速,早期容易并發(fā)膿毒血癥至感染性休克、呼吸衰竭、多臟器功能衰竭而致患者臨床死亡。治療ACST的關(guān)鍵是早期進(jìn)行膽道減壓、暢通引流,ENBD和PTCD都是有效的膽道減壓引流措施,可迅速緩解病情、提高ACST患者的生存率;清熱利膽是祖國(guó)醫(yī)學(xué)治療梗阻性急性重癥膽管炎的重要方法,在膽道減壓引流術(shù)后應(yīng)用清熱利膽顆粒(QRLD)可以增強(qiáng)ENBD和PTCD膽道減壓引流效果,有效減少ERCP術(shù)后胰腺炎的發(fā)生、促進(jìn)引流術(shù)后患者炎癥水平的降低和肝功能的恢復(fù),療效肯定,值得在臨床推廣應(yīng)用。
[Abstract]:Objective: to investigate the application of endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic bile duct drainage (PTCD) in acute severe cholangitis (ACST) and the intervention effect of Qingre Lidan granule (QRLD). Methods: from January 2013 to January 2017, ACST patients undergoing ENBD or PTCD bile duct decompression and drainage were selected as the subjects. According to the 1983 National Symposium on Biliary Surgical Diseases, all patients met the diagnostic criteria of acute severe cholangitis. The patients were divided into four groups according to whether or not the hospital preparation Qingre Lidan granule (QRLD) was used: the patients in ENBD group were treated with endoscopic nasobiliary drainage alone; the patients in ENBD combined with QRLD group were treated with Qingre Lidan granule after ENBD; the patients in PTCD group were treated with PTCD drainage alone; and the patients in PTCD group were treated with traditional Chinese medicine Qingre Lidan granule after PTCD drainage. The inflammatory level (total leukocyte count, granulocyte percentage), jaundice level (total bilirubin), liver function (ALT,AST), postoperative drainage volume and body temperature of the four groups were statistically analyzed before and one week after operation, and the auxiliary effect of Qingre Lidan granule on ENBD or PTCD drainage was evaluated. The total effective rate, mortality and incidence of complications in each group were statistically analyzed, and the curative effect of Qingre Lidan granule in the treatment of ACST was observed. Results: from January 2013 to January 2017, a total of 96 patients with ENBD or PTCD were treated in our department. All patients met the diagnostic criteria of (ACST). According to their severity, they could be divided into grade 鈪，

本文編號(hào)：2506657