导丝引导法经皮经肝穿刺胆道引流与传统穿刺在急性梗阻性化脓性胆管炎中的应用对比

摘要/Abstract

摘要： 目的对比导丝引导法经肝穿刺胆道引流(PTBD)与传统穿刺在急性梗阻性化脓性胆管炎(AOSC)中的应用效果。方法将2019年1月至2024年1月本院接收的92例AOSC患者设为研究对象,随机分为对照组与观察组,各46例。对照组接受传统PTBD,观察组接受导丝引导PTBD。记录患者围术期指标,并比较两组术前和术后24 h的炎性因子水平、应激指标,术后1周评估肝功能并记录并发症。结果观察组和对照组手术时间分别为(75.31±13.37)min和(73.42±11.42)min,一次性置入成功率分别为100%和93.48%,每日引流量分别为(287.26±35.61)mL和(283.14±31.35)mL,两组比较差异均无统计学意义(P＞0.05)。观察组术后24 h的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)分别为(71.23±7.63)pg/mL、(354.23±39.36)pg/mL、(649.05±67.63)pg/mL,低于对照组(P<0.05)。两组肝功能差异无统计学意义(P＞0.05)。对照组术后出现5例胆道出血、2例胆漏、7例急性重症胆管炎、6例脓毒症;观察组术后出现4例胆道出血、2例急性重症胆管炎、1例脓毒症。结论导丝引导法PTBD较传统穿刺能更有效降低急性梗阻性化脓性胆管炎患者的术后炎性反应及应激水平,且并发症发生率更低,但两者对肝功能的影响无明显差异。

关键词: 导丝引导, 经皮经肝穿刺胆道引流, 急性梗阻性化脓性胆管炎, 肝功能

Abstract: Objective To compare the application effects of wire-guided percutaneous transhepatic biliary drainage (PTBD) and conventional puncture in the treatment of acute obstructive suppurative cholangitis (AOSC). Methods A total of 92 patients with AOSC who received treatment in our hospital from January 2019 to January 2024 were enrolled as the study subjects. They were randomly assigned to a control group (n=46) and an observation group (n=46). The control group underwent conventional PTBD, while the observation group underwent wire-guided PTBD. Perioperative indicators were recorded, and preoperative and postoperative (24 h) inflammatory cytokine levels and stress indices were compared between the two groups. Liver function was assessed 1 week postoperatively. Postoperative complications such as biliary tract hemorrhage, bile leakage, acute severe cholangitis, and sepsis were recorded. Results The operative time was (75.31 ± 13.37) min in the observation group and (73.42 ± 11.42) min in the control group, with one-time placement success rates of 100% and 93.48%, and daily drainage volumes of (287.26 ± 35.61) mL and (283.14 ± 31.35) mL, respectively. The differences were not statistically significant (P>0.05). At 24 hours postoperatively, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) in the observation group were (71.23 ± 7.63)pg/mL, (354.23 ± 39.36)pg/mL, and (649.05 ± 67.63) pg/mL, respectively, which were lower than those in the control group (P<0.05). No significant differences were observed in liver function indicators between the two groups at 1 week postoperatively (P>0.05). Postoperative complications in the control group included 5 cases of biliary hemorrhage, 2 cases of bile leakage, 7 cases of acute severe cholangitis, and 6 cases of sepsis, while the observation group had 4 cases of biliary hemorrhage, 2 cases of acute severe cholangitis, and 1 case of sepsis, with no bile leakage. Conclusion Wire-guided PTBD is more effective than conventional puncture in reducing postoperative inflammatory responses and stress levels in patients with AOSC, with a lower complication rate. However, there is no significant difference in their impact on liver function.

Key words: Wire-guided, Percutaneous transhepatic biliary drainage, Acute obstructive suppurative cholangitis, Liver function

吴先臣, 陈闯, 李加洲, 李小庆. 导丝引导法经皮经肝穿刺胆道引流与传统穿刺在急性梗阻性化脓性胆管炎中的应用对比[J]. 肝脏, 2026, 31(1): 123-126.

WU Xian-chen, CHEN Chuang, LI Jia-zhou, LI Xiao-qing. Comparison of wire-guided percutaneous transhepatic biliary drainage and conventional puncture in the treatment of acute obstructive suppurative cholangitis[J]. Chinese Hepatolgy, 2026, 31(1): 123-126.

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