ERCP联合吡喹酮治疗肝吸虫病并发胆道梗阻患者临床疗效研究

摘要/Abstract

摘要： 目的探讨经内镜逆行性胰胆管造影术(ERCP)联合吡喹酮治疗肝吸虫感染并发胆道梗阻的临床效果。方法将我院2016年1月—2018年1月收治的肝吸虫感染伴胆道梗阻患者33例,同时回顾性分析我院既往收治的肝吸虫感染伴胆道梗阻患者33例的临床资料,其中接受ERCP术联合吡喹酮治疗的33例,接受ERCP手术治疗的33例,所有患者入院后均接受抗吸虫病治疗。对比两组手术成功率、住院时间、住院费用及术后并发症发生情况各项数据,对比两组治疗前后谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBil)、碱性磷酸酶(ALP)水平变化,另外统计ERCP术联合吡喹酮组用药后不良反应发生情况。结果两组手术有效率及住院时间、住院费用对比差异无统计学意义(P>0.05)。治疗前,两组ALT、GGT、ALP、TBil水平对比差异无统计学意义(P>0.05);治疗后,两组ALT、GGT、ALP、TBil水平呈下降趋势,但组间对比差异无统计学意义(P>0.05);治疗后,两组ALT、GGT、ALP、TBil水平呈下降趋势,组内对比显著低于治疗前,差异有统计学意义(P<0.05)。两组术后并发症总发生率对比差异无统计学意义(P>0.05)。ERCP术联合吡喹酮组用药后出现头痛、头晕、心动过速各1例,ERCP组未见明显不良反应;其中头痛、头晕均为轻微反应,未经特殊处理均自行缓解,心动过速经对症治疗后好转。结论 ERCP术联合吡喹酮治疗肝吸虫感染伴胆道梗阻安全有效,在解除胆道梗阻的同时还能对肝吸虫病进行杀灭,能够改善患者肝功能,值得临床应用。

关键词: 肝吸虫感染, 胆道梗阻, ERCP术, 肝功能

Abstract: Objective To investigate the clinical effect of ERCP combined with praziquantel in the treatment of hepatic fluke infection complicated with biliary obstruction. Methods The clinical data of 33 patients with liver fluke disease complicated with biliary obstruction admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed at the same time as the clinical data of 33 patients with liver fluke infection and biliary obstruction previously admitted to our hospital. Among them, 33 cases received ERCP combined with praziquantel treatment, 33 cases received ERCP surgery, and all patients received anti-tremoria treatment after admission. Compare the data of surgical success rate and postoperative complications, length of hospital stay, hospital expenses of the two groups, compare the alanine aminotransferase(ALT), gamma-GGTP (gamma glutamyl transpeptidase) (GGT), total bilirubin (TBIL) and alkaline phosphatase (ALP) levels before and after treatment in the two groups. In addition, statistics on the occurrence of adverse reactions after ERCP surgery combined with praziquantel. Results There was no significant difference between the two groups in effective rate, length of stay and cost of stay (P>.05). Before treatment, there was no significant difference in ALT, GGT, ALP and TBil between the two groups (P>0.05). After treatment, the levels of ALT, GGT, ALP and TBil decreased in the two groups, but there was no significant difference between the two groups (P>0.05). After treatment, the levels of ALT, GGT, ALP and TBil in the two groups showed a downward trend, and the intra-group comparison difference was significantly lower than that before treatment, with statistically significant differences (P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (P>.05). Headache, dizziness and tachycardia occurred in 1 case after ERCP combined with praziquantel, and no obvious adverse reactions were observed in ERCP group. Headache and dizziness were mild reactions, which were relieved by themselves without special treatment. Tachycardia improved after symptomatic treatment. Conclusion ERCP combined with praziquantel for the treatment of liver fluke infection complicated with biliary tract obstruction is safe and effective, which can eliminate the biliary tract obstruction and kill the liver fluke at the same time, and can improve the liver function of patients, which is worthy of clinical application.

Key words: Liver fluke infection, Biliary obstruction, ERCP operation, Liver function

邓琰, 吴凡, 陈芦斌, 李宁宇, 寇伟伟, 王云. ERCP联合吡喹酮治疗肝吸虫病并发胆道梗阻患者临床疗效研究[J]. 肝脏, 2020, 25(9): 968-971.

DENG Yan, WU Fan, CHEN Lu-bin, LI Ning-ning, KOU Wei-wei, WANG Yun. Clinical study of ERCP combined with praziquantel in the treatment of hepatic fluke infection complicated with biliary obstruction[J]. Chinese Hepatolgy, 2020, 25(9): 968-971.

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