The Application Of ENBD And PTCD Drainage In Acute Cholangitis Of Severe Type Caused By Bile Duct Stones And The Intervention Of Traditional Chinese Medicine QingReLiDan Granule

Objectives:To investigate the effect of the traditional chinese medicine Qing Re Li Dan(QRLD)granule combined with endoscopic nasobiliary drainage(ENBD)and percutaneous transhepatic cholangial drainage(PTCD)in treatment of acute cholangitis of severe type(ACST).Methods:ACST patients were selected as the object of this study hospitalized in our department from January 2013 to 2017 January,all received minimally invasive biliary drainage.All patients were in line with the diagnostic criteria of acute cholangitis of severe type according to the National Biliary Surgery Symposium in 1983.All patients were divided into four group:ENBD group treated with endoscopic nasobiliary drainage only,PTCD group treated with percutaneous transhepatic cholangial drainage only,ENBD combined with QRLD granule group treated with additional Qingre Li Dan granule after endoscopic nasobiliary drainage as well as PTCD combined with QRLD granule group.Preoperative and postoperative levels of inflammation(total leukocyte count,percentage of granulocytes),jaundice level(total bilirubin)and liver function(ALT,AST)were analyzed in order to evaluate the enhancing effect of QRLD granule on biliary drainage.The total effective rate,mortality rate,complication rate and hospitalization days were analyzed statistically so as to observe the effect of QRLD granule in the treatment of ACST.Results:96 patients all were treated with biliary decompression drainage.All patients were in accordance with the diagnostic criteria of ACST.According to its severity all patients can be divided into four grade including grade?(52 cases),grade?(22cases),grade?(6 cases),grade ?(16 cases).There were 61 patients received biliary drainage treatment including 33 patients performed with ENBD and 28 patients with PTCD treatment.The remaining 35 patients were treated with oral QRLD granules,including ENBD combined with QRLD granule 19 cases and PTCD treatment combined with QRLD granule 16 Cases.Statistical analysis showed that there were no significant differences in the general status of the four groups in terms of age,sex,morbidity,comorbidities,comorbidities and previous biliary tract surgery(P>0.05).Compared with preoperative,the levels of inflammation(WBC count,percentage of granulocytes),jaundice level(total bilirubin)and liver function(ALT,AST)in the four groups were significantly improved on the seventh day after surgery(P <0.05).Compared with the corresponding groups,the level of inflammation and the level of jaundice were lower in patients treated with QRLD granule group than in merely ENBD or PTCD treatment group.Total effective rate and mortality rate,the incidence of complications compared with the simple drainage group,the total effective rate of patients with traditional Chinese medicine group was significantly improved and the incidence of complications was lower.Conclusions:Acute cholangitis of severe type(ACST)characterized by sudden onset,fast progression and easily complicated by sepsis even septic shock,respiratory failure and multiple organ failure,often cause clinical death in patients.The essential to treat thus disease need early bile duct decompression and unobstructed drainage.ENBD or PTCD drainage all is the effective measures,it can quickly alleviate the deterioration state,raise the survival rate of patients with ACST.Qingrelidan is an important method of traditional chinese medicine to cure obstructive acute cholangitis of severe type.The application of QRLD granule can enhance the effect of ENBD and PTCD treatment on biliary decompression drainage,further reducing the mortality of ACST patients,and fundamentally improve the prognosis.It worthy of expanding clinical application.