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经内镜逆行胰胆管造影治疗急性梗阻性化脓性胆管炎的疗效分析
Efficacy of therapeutic endoscopic retrograde cholangiopancreatography in treatment of acute obstructive suppurative cholangitis
文章发布日期:2015年09月06日  来源:  作者:何朝晖,祝伟,谢萍  点击次数:977次  下载次数:268次

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【摘要】:目的评价经内镜逆行胰胆管造影(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)的疗效,检测胆汁细菌培养和药敏结果。方法回顾性分析2009年11月-2014年11月遵义医学院第五附属(珠海)医院收治的150例AOSC患者,所有患者均行ERCP治疗,治疗中抽取患者胆汁,进行细菌培养及药敏测定,并根据测定结果选择抗生素,评价疗效。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果总插管成功率为92%(138/150),引流有效率为94.2%(130/138);有效引流的130例患者TBil和DBil水平治疗后较治疗前显著减少[(60.3±43.4)μmol/L vs (110.2±53.1)μmol/L,(35.5±23.6)μmol/L vs (65.5±33.2)μmol/L],差异均具有统计学意义(t值分别为8.56、8.65,P值均<0.05);中性粒细胞百分比较治疗前显著下降(652% vs 83.4%)(χ2=11.85, P<0.05);胆汁培养以革兰阴性菌为主,占胆汁培养阳性标本总数的85.7%(78/91),加入酶抑制剂的β内酰胺类抗生素可做为首选用药,碳青霉烯类抗生素可做为二线用药。结论ERCP是治疗AOSC的一种简便有效的方法,根据患者胆汁标本的培养结果选用抗生素,可迅速缓解患者中毒症状,预防耐药性的产生。
【Abstract】:ObjectiveTo investigate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute obstructive suppurative cholangitis (AOSC), and to examine the results of bile bacterial culture and drug susceptibility test. MethodsA retrospective analysis was performed on 150 AOSC patients who were admitted to the Fifth Affiliated Hospital of Zunyi Medical University from November 2009 to November 2014. All patients underwent ERCP. The bile of patients was collected during treatment. Antibiotics were chosen according to the results of bile bacterial culture and drug susceptibility test. The efficacy of ERCP was assessed. Comparison of continuous data between groups was made by independent-samples t test, while comparison of categorical data by chi-square test. ResultsThe rate of successful intubation was 92% (138/150), and the rate of effective drainage was 94.2% (130/138). After treatment, the 130 patients treated with effective drainage had significantly reduced total bilirubin and direct bilirubin (60.3±43.4 μmol/L vs 110.2±53.1 μmol/L, t=8.56, P<0.05; 35.5±23.6 μmol/L vs 65.5±33.2 μmol/L, t=8.65, P<0.05) and a significantly reduced percentage of neutrophils (65.2% vs 83.4%, χ2=11.85, P<0.05). The results of bile bacterial culture showed that Gram-negative bacteria were found in 85.7% (78/91) of positive specimens. The β-lactam antibiotics with enzyme inhibitor could be used as the preferred drug, and carbapenems as second-line drugs. ConclusionECRP is a simple and effective therapy for AOSC. Antibiotics, chosen based on the results of bile bacterial culture, can quickly relieve symptoms of poisoning and prevent drug resistance.
【关键字】:胆管炎;胆汁淤积;胰胆管造影术,内窥镜逆行
【Key words】:cholestasis;cholangitis; cholangiopancreatography, endoscopic retrograde
【引证本文】:何朝晖, 祝伟, 谢萍. 经内镜逆行胰胆管造影治疗急性梗阻性化脓性胆管炎的疗效分析[J]. 临床肝胆病杂志, 2015, 31(10): 1641-1644.

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