内镜下逆行胰胆管造影术在胆瘘治疗中的作用

Clinical efficacy of ERCP in treatment of biliary fistula

摘要:

目的 胆瘘为肝胆术后较为常见的并发症，再次手术治疗创伤大，且增加患者经济负担。随着内镜下逆行胰胆管造影术（ERCP）的发展，微创手术逐渐成为更多患者和医生的选择。该研究旨在探讨ERCP治疗胆瘘的有效性。方法 回顾性分析2017年1月－2020年10月于该院确诊的胆瘘患者的临床资料，根据治疗方式分为观察组（n = 46）和对照组（n = 35），观察组行ERCP治疗，对照组行保守治疗，比较两组治疗有效率、并发症发生率、二次手术率、住院费用、住院时间和恢复正常饮食时间。结果 观察组治疗有效率95.7%（44/46），对照组54.3%（19/35），两组比较，差异有统计学意义（P = 0.000）；观察组中2例（4.3%）行二次手术，对照组16例（45.7%），两组比较，差异有统计学意义（P = 0.000）；观察组住院时间为（14.0±6.0）d，对照组（19.1±14.6）d，两组比较，差异有统计学意义（P = 0.036）；观察组住院费用为（40 368.8±12 114.5）元，对照组（59 531.2±17 448.8）元，两组比较，差异有统计学意义（P = 0.000）；观察组恢复正常饮食时间为（1.4±0.7）个月，对照组恢复时间为（1.8±0.7）个月，两组比较，差异有统计学意义（P = 0.044）；观察组术后并发症发生率为26.1%（12例），对照组17.1%（6例），两组比较，差异无统计学意义（P = 0.337）。结论 ERCP治疗胆瘘较保守治疗具有治疗有效率高、二次手术率低、住院时间和住院费用相对较少的优势，但并发症发生率较保守治疗差异无统计学意义。

Abstract:

Objective To explore the efficacy of ERCP in the treatment of biliary fistula.Methods Retrospectively analysis of the clinical data of 81 patients with biliary fistula from Jan 2017 to Oct 2020 was conducted. According to the treatment, the patients were divided into observation group (n = 46) and control group (n = 35), observation group with ERCP treatment and control group with conservative treatment, compared the two groups of treatment effectiveness, incidence of complication rate, secondary surgery rate, hospitalization expense and length of hospital stay.Results Of which 95.7% were effective (44/46) in observation group, and 54.3% (19/35) in control group (P = 0.000); Two patients (4.3%) in observation group underwent secondary surgery, and 16 patients (45.7%) in control group (P = 0.000); The average length of hospital stay in observation group was (14.0 ± 6.0) d and in control group was (19.1 ± 14.6) d (P = 0.036). The average hospitalization expense was (40 368.8±12 114.5) in observation group and (59 531.2±17 448.8) in control group (P = 0.000). In the observation group, the recovery time was (1.4 ± 0.7) months, while in the control group, the recovery time was (1.8 ± 0.7) months (P = 0.044). 12 patients (26.1%) in the observation group had postoperative complications, while 6 patients (17.1%) in control group (P = 0.337).Conclusion ERCP treatment was more effective than conservative treatment, the rate of secondary surgery was lower, the length of hospitalization and the cost of hospitalization were relatively less. But there was no significant difference in incidence of complications rate.