摘要
目的探讨经内镜逆行胰胆管造影(ERCP)与经皮经肝穿刺胆道造影(PTCD)对急性梗阻性化脓性胆管炎(AOSC)患者疗效及对血清α-谷胱甘肽S转移酶(α-GST)、胆汁炎症因子的影响。方法本研究为前瞻性研究,选取咸阳市第一人民医院2021年1月—2024年4月收治的120例老年AOSC患者为研究对象,按照随机数字表法分为观察组及对照组,每组60例。观察组行ERCP术,对照组行PTCD术,对比两组症状缓解时间、术后住院时间、肝脏生化指标[血清直接胆红素(DBIL)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]、血清α-GST及胆汁炎症因子[白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)],并统计分析术后并发症发生情况。结果两组腹痛、发热及黄疸缓解时间对比,组间无显著差异(P>0.05),观察组术后住院时间显著短于对照组(P<0.05)。与术前血清DBIL、TBIL、ALT及AST相比较,两组术后7 d以上指标均下降(P<0.05),但两组以上指标同期比较无显著差异(P>0.05)。与术前血清α-GST水平对比,两组术后7 d血清α-GST水平均下降,且观察组血清α-GST水平较对照组更低(P<0.05)。与术后1 d胆汁IL-6、IL-10以及TNF-α水平比较,两组术后7 d胆汁IL-6、TNF-α水平下降,胆汁IL-10升高,且观察组术后7 d上述指标均优于对照组(P<0.05)。观察组、对照组术后并发症总发生率分别为10.00%、5.00%,组间未见明显差异(P>0.05)。结论ERCP与PTCD均能促进老年AOCS患者临床症状缓解,改善肝脏功能,但ERCP在降低血清α-GST水平及减轻炎症反应方面优势更为明显。
Objective To analyze the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cholangial drainage(PTCD)on elderly patients with acute obstructive suppurative cholangitis(AOSC),and the impact on serum alpha-glutathione S-transferase(alpha-GST)and bile inflammatory factors.Methods This study was a prospective study.A total of 120 elderly patients with AOSC who were admitted to the Xianyang First People's Hospital from January 2021 to April 2024 were assigned to observation group and control group using the random number table method,with 60 patients in each group.Observation group underwent ERCP and control group underwent PTCD.The two groups were compared in terms of the time to symptom relief,postoperative hospital stay,liver biochemical indicators[serum direct bilirubin(DBIL),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)],serum alpha-GST and bile inflammatory factors[interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)].The incidence rates of postoperative complications were statistically analyzed.Results There was no significant difference in the time to abdominal pain,fever and jaundice relief between the two groups(P>0.05).Postoperative hospital stay of observation group was significantly shorter than that of control group(P<0.05).Serum DBIL,TBIL,ALT and AST levels in both groups on day 7 after operation were lower than preoperative levels(P<0.05),but there was no significant difference between the groups(P>0.05).Serum alpha-GST levels in both groups on day 7 after operation were lower than preoperative levels(P<0.05),and serum alpha-GST level in observation group was lower than that in control group(P<0.05).Compared with postoperative day 1,there were decreases in bile IL-6 and TNF-αlevels,and increases in bile IL-10 levels in both groups on postoperative day 7(P<0.05).Above indicators in observation group were better than those in control group(P<0.05).The total incidence rates of postoperative complications in observation group and control group were 10.00%and 5.00%,without significant difference between the groups(P>0.05).Conclusion Both ERCP and PTCD can promote clinical symptom relief and improve liver function in elderly patients with AOCS.However,ERCP has more advantages in lowering serum alpha-GST level and alleviating inflammatory reactions.
作者
李小庆
贾蓬勃
李栋
李博
王新团
LI Xiaoqing;JIA Pengbo;LI Dong;LI Bo;WANG Xintuan(Department of Hepatobiliary,Pancreatic and Spleen Surgery,The First People's Hospital of Xianyang,Xianyang 712000,Shaanxi,China)
出处
《西部医学》
2025年第7期1053-1057,共5页
Medical Journal of West China
基金
陕西省自然科学基础研究计划项目(2022JM8019)。
关键词
急性梗阻性化脓性胆管炎
老年
经内镜逆行胰胆管造影
经皮经肝穿刺胆道造影
α-谷胱甘肽S转移酶
胆汁炎症因子
Acute obstructive suppurative cholangitis
Elderly
Endoscopic retrograde cholangiopancreatography
Percutaneous transhepatic cholangial drainage
Alpha-glutathione S-transferase
Bile inflammatory factor
