CAJ | 학술논문

目的：评价应用超声引导下经皮肝穿刺胆囊置管引流治疗急性重症胆源性胰腺炎的临床效果，并观察并发症发生情况。方法：采用回顾性研究方法，收集皖南医学院附属弋矶山医院重症医学科自2010年12月～2013年7月应用超声引导下经皮肝穿刺胆囊置管引流术治疗急性重症胆源性胰腺炎患者23例临床资料，分别于穿刺前、穿刺后第3天比较患者临床症状（腹痛、腹胀、恶心、发热、呼吸困难）及各项指标变化（白细胞、降钙素原、C-反应蛋白、淀粉酶、脂肪酶、转氨酶、胆红素、APACHE Ⅱ评分、Balthazar CT 评分、MODS评分），并观察并发症发生情况（出血、胆漏、肠道损伤、导管易位，导管滑脱）。结果：23例患者中成功实施经皮肝穿刺胆囊置管引流术21例（91．3％）。与治疗前比较，患者治疗后第3天临床症状均明显缓解，大部分生化指标及危重病相关评分均明显下降（P＜0．05），而谷丙转氨酶变化差异无统计学意义（P＞0．05）。有2例患者因穿刺后出血导致穿刺失败，1例经积极止血输血治疗后出血停止，另1例经外科手术止血。所有患者中发生胆漏1例（4．8％），经积极引流治疗后缓解；发生导管易位引流不畅2例（9．5％）；发生非计划拔管1例（4．8％），后改为手术治疗；未发生肠道损伤并发症。结论：应用超声引导下经皮肝穿刺胆囊置管引流治疗急性重症胆源性胰腺炎可有效缓解患者临床症状，改善临床指标及相关危重病评分，具有一定的疗效优势。
목적：평개응용초성인도하경피간천자담낭치관인류치료급성중증담원성이선염적림상효과，병관찰병발증발생정황。방법：채용회고성연구방법，수집환남의학원부속익기산의원중증의학과자2010년12월～2013년7월응용초성인도하경피간천자담낭치관인류술치료급성중증담원성이선염환자23례림상자료，분별우천자전、천자후제3천비교환자림상증상（복통、복창、악심、발열、호흡곤난）급각항지표변화（백세포、강개소원、C-반응단백、정분매、지방매、전안매、담홍소、APACHE Ⅱ평분、Balthazar CT 평분、MODS평분），병관찰병발증발생정황（출혈、담루、장도손상、도관역위，도관활탈）。결과：23례환자중성공실시경피간천자담낭치관인류술21례（91．3％）。여치료전비교，환자치료후제3천림상증상균명현완해，대부분생화지표급위중병상관평분균명현하강（P＜0．05），이곡병전안매변화차이무통계학의의（P＞0．05）。유2례환자인천자후출혈도치천자실패，1례경적겁지혈수혈치료후출혈정지，령1례경외과수술지혈。소유환자중발생담루1례（4．8％），경적겁인류치료후완해；발생도관역위인류불창2례（9．5％）；발생비계화발관1례（4．8％），후개위수술치료；미발생장도손상병발증。결론：응용초성인도하경피간천자담낭치관인류치료급성중증담원성이선염가유효완해환자림상증상，개선림상지표급상관위중병평분，구유일정적료효우세。
Objective:To observe the clinical efficacy and complications of endoscopic ultrasound guided percutaneous transhepatic gallbladder drainage ( PTGD ) for patients with severe acute biliary pancreatitis . Methods: The clinical date were retrospectively examined in 23 cases of severe acute biliary pancreatitis undergone PTGD between December 2010 and July 2013 in our department.The total cases were compared regarding the clinical symptoms( abdominal pain,abdominal distention,nausea,body temperature and dyspnea) at the 3rd day before and after the procedure and changes of biochemical indicators, including white blood cell ( WBC ) , procalcitonin ( PCT ) , c-reactive protein ( CRP ) , amylase (AMY),lipase(LPS),glutamate-pyruvate transaminase(GPT),total bili-rubin(T-Bil)as well as prognostic scores of Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ),CT severity index(Balthazar score)and Multiple organ dysfunction syndrome(MODS),respectively,and observed with the postoperative complications ( bleeding, biliary leakage, intestinal injury and catheter dislocation and detachment ) .Results:Successful PT-GD in 21 of the 23 cases(91.3%) resulted in evident relief of clinical symptoms and down-regulation of the biochemical indexes and prognostic scores described above(P<0.05),though there was no statistical signifi-cance with the variation of GPT(P >0.05),as compared with those re-corded at the 3rd day before intervention.Failure in 2 cases due to bleed-ing after applying the catheter was managed with hemostasis by either blood transfusion or surgical intervention.Additionally,biliary leakage oc-curred in 1 case(4.8%)who was treated with subsequent active drainage and inadequate drainage due to catheter dislocation in 2(9.5%).Another 1 case required early catheter removal and was referred to surgical man-agement.There was no incidence of intestinal injury for the total cases . Conclusion: Ultransound guided PTGD for patients with severe acute bil-iary pancreatitis may be preferable,for the technique can lead to effective relief the patient′s clinical symptoms and improvement of the clinical in-dexes and prognostic scores.