CAJ | 학술논문

目的探讨胆总管末端植入金属支架后早期肠胆反流状况和反流性胆管炎的发生机制.方法 16例无胆系感染并排除肠梗阻及肠道、胆道手术病史的恶性低位胆管梗阻患者,通过经皮经肝胆管穿刺及单纯外引流后,于胆总管末端植入金属网状支架.在植入支架前进行血白细胞计数、中性粒细胞百分比和总胆红素、直接胆红素含量的检测.支架植入后2～5 d再次检查上述各项指标,并于拔管前2 h口服含有99锝m-二乙三氨五醋酸(99Tcm-DTPA)的水,2 h后检测胆汁中核素的放射性活度.对研究获得的计量资料,采用配对t检验或秩和检验,P＜0.05为差异有统计学意义.结果支架植入后2～5 d,14例进行了胆汁99Tcm检测,其中12例于拔管前2 h胆汁中检测到99Tcm活度,放射计数占总摄入剂量的1.82%.2例胆汁中未检测到99Tcm.14例进行胆汁核素检测的患者均没有出现高热、寒战、黄疸加重的胆管炎表现,血白细胞计数和中性粒细胞百分比分别为(7.59±2.62)×109/L、0.74,与支架植入前的(7.94±3.84)×109/L和0.68相比,差异均没有统计学意义(分别为t=0.423、Z=1.036,P值均＞0.05);而血总胆红素和直接胆红素值的中位数分别为92.2和74.3 μmol/L,明显低于支架植入前的202.6和154.7 μmol/L,差异均具有统计学意义(Z值均为-3.170,P值均＜0.05).结论胆总管末端植入支架后,早期就有较高的肠胆反流发生率,但没有反流性胆管炎的发生.
목적 탐토담총관말단식입금속지가후조기장담반류상황화반류성담관염적발생궤제.방법 16례무담계감염병배제장경조급장도、담도수술병사적악성저위담관경조환자,통과경피경간담관천자급단순외인류후,우담총관말단식입금속망상지가.재식입지가전진행혈백세포계수、중성립세포백분비화총담홍소、직접담홍소함량적검측.지가식입후2～5 d재차검사상술각항지표,병우발관전2 h구복함유99득m-이을삼안오작산(99Tcm-DTPA)적수,2 h후검측담즙중핵소적방사성활도.대연구획득적계량자료,채용배대t검험혹질화검험,P＜0.05위차이유통계학의의.결과 지가식입후2～5 d,14례진행료담즙99Tcm검측,기중12례우발관전2 h담즙중검측도99Tcm활도,방사계수점총섭입제량적1.82%.2례담즙중미검측도99Tcm.14례진행담즙핵소검측적환자균몰유출현고열、한전、황달가중적담관염표현,혈백세포계수화중성립세포백분비분별위(7.59±2.62)×109/L、0.74,여지가식입전적(7.94±3.84)×109/L화0.68상비,차이균몰유통계학의의(분별위t=0.423、Z=1.036,P치균＞0.05);이혈총담홍소화직접담홍소치적중위수분별위92.2화74.3 μmol/L,명현저우지가식입전적202.6화154.7 μmol/L,차이균구유통계학의의(Z치균위-3.170,P치균＜0.05).결론 담총관말단식입지가후,조기취유교고적장담반류발생솔,단몰유반류성담관염적발생.
Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilirubin and direct bilirubin in blood were performed for all patients. Two to five days [ an average of (3.3 ±0. 9) days ] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P ＜ 0. 05 was considered to be statistically different Results In 14 cases, radioactivity was successfully detected in the bile 2-5 days after stent implantation. Twelve of them was detected to have radioactivity in the bile 2 hours before extubation with duodenal-biliary reflux. The technetium count in the bile accounted for 1.82% of the total intake dose. There was no radioactivity in the bile in 2 cases. In 14 patients, there were no symptoms of cholangitis such as high fever, chills, increased jaundice, and so on after stent implantation. The mean of white blood cell count was (7.59 t2. 62) × 109/L, and the median of neutrophil percentage was 0. 74. Compared with those before stent implantation, the difference did not reach statistical significance ( t = 0. 423, Z = 1. 036, P ＞ 0. 05 ).After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92. 2 and 74. 3 μmol/L. Compared with those before stenting,the difference was statistically significant (Z= -3. 170, -3. 170, P ＜0.05). Conclusions There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux.