Analysis Of The Curative Effect Of Biliary Drainage In The Early Treatment Of Severe Acute Cholangitis

OBJECTIVE: To study the role of biliary drainage in the treatment of acute severe cholangitis,compare different drainage methods in order to guide the early treatment of severe cholangitis.Methods: Case Collection:Collected 192 cases which are in line with severe cholangitis diagnosis from January 2000 to January 2017 in our hospital.These cases,whose etiology is common bile duct stones the cause of stones,are in line with the diagnostic criteria for severe cholangitis,without concurrent pancreatitis,liver abscess and other diseases,and accept the the treatment of surgical drainage,bile duct drainage or endoscopic drainage.According to the different treatment methods,these cases are divided into: Surgery group(thoracotomy incision drainage)68 cases;PTCD group,(percutaneous transhepatic bile duct drainage)64 cases;ERCP group,(endoscopic retrograde cholangiopancreatography biliary drainage)60 cases.The age,sex,underlying disease,systemic organ dysfunction,Clinical symptoms,white blood cells,neutrophils,ALT,AST,ALP,GGT,T-BIL were measured before treatment.The levels of white blood cells,body temperature,heart rate,white blood cells,neutrophils,ALT,AST,ALP,GGT,T-BIL,Clinical symptom remission rate,duration of operation,length of hospitalization,death and adverse events were collected on the third day after treatment.Analytical method:SPSS24.0 statistical software was used to analyze the data.For quantitative data such as white blood cells and hospitalization days,single factor analysis of variance.was used and SNK-q test was for a statistically significant difference.For the sex,mortality and other ratio(or rate)data,cross-linked table for chi-square test was used,two groups of chi-square test for a statistically significant difference.Test level α take 0.05,p value <0.05,meaning statistical differences.Result:1.A total of 192 patients were collected,Surgery group of 68 cases,64 cases of PTCD group and ERCP group of 60 cases.compare between three groups,following aspect such as sex ratio,preoperative leukocytes,neutrophils,liver function,clinical symptoms,basal diseases,nervous system,respiratory system,blood system,liver and kidney function,p value more than 0.05,Indicate that there were no differences meaning the three groups of patients are comparable.2.The levels of WBC,NEUT,ALT,AST,ALP,GGT and TBIL in the three groups were significantly lower than those preoperative ones,which indicated that bile duct drainage had important effect on the control of severe cholangitis infection,recovery of liver function and reduction of jaundice.3.Compare the postoperative level of ALT,AST,ALP,GGT,TBIL between three groups of patients,the p value greater than 0.05,indicating that the there are no difference in the recovery of liver function,control jaundice between three groups of patients.4.Compare three groups of patients in the relief of abdominal pain,p value is less than 0.05,the same as between the two groups,found that,ERCP for patients with the best relief of abdominal pain,followed by PTCD.In the body temperature control,compare the three groups,the p value of less than 0.05.Compare ERCP and PTCD the p value of more than 0.05.Compare both groups with Surgery group,the p value of less than 0.05,indicating that ERCP,PTCD are conducive to patient temperature control.5.In the operation time,comparethe three groups the p value is less than 0.05,the same as between the two groups indicating that the operation time,the shortest PTCD,ERCP followed.In the hospital days,compare the three groups,the p value of less than 0.05.Compare ERCP and PTCD the p value is more than 0.05.Compare both groups with Surgery group,the p value of less than 0.05,indicating that ERCP,PTCD are conducive to recovery.In the recovery of diet,comparethe three groups the p value is less than 0.05,the same as between the two groups indicating that ERCP is best for tgastrointestinal function recovery,followed by PTCD.Compare three groups of patients in the mortality rate,the p value is less than 0.05,Compare ERCP and PTCD the p value is more than 0.05.Compare both groups with Surgery group,the p value of less than 0.05,meaning the mortality of ERCP and PTCD is lower than surgery.Compare incidence of adverse events between three groups,the p value is less than 0.05,the same as between the two groups indicating that the incidence of adverse events of ERCP was lowest,followed by PTCD.6.For patients with circulatory failure,from the mortality rate,the incidence of adverse events,p values are less than 0.05,indicating that the treatment of three drainage methods are different,ERCP and PTCD were lower than operative mortality and adverse events,and the incidence of adverse events ERCP was lower than PTCD.7.For patients with MOF,from the mortality rate,the incidence of adverse events,the three groups are different,p values were less than 0.05,indicating that surgery group mortality,adverse events were higher.ERCP and PTCD is same.8.For patients older than 65 years of age,from the mortality rate,the incidence of adverse events,the three groups were more visible,p values were less than 0.05,indicating that the three groups were different.ERCP and PTCD were lower than operative mortality and adverse events,and the incidence of adverse events ERCP was lower than PTCD.Conclusion:Biliary drainage is beneficial to severe cholangitis in patients with infection control,yellowing,and recovery of liver function.ERCP,PTCD for mortality and adverse events in the lower than surgery especially for circulatory failure,multiple organ failure or elderly patients,however the surgical treatment has the advantage of drainage,remove the obstruction stones and excision of the gallbladder at the same time.In addition ERCP,PTCD surgery also has a short operating time,good infection control,high rate of symptom relief,fast diet,short hospital stay.ERCP can simultaneously remove stones and bile duct drainage,is more conducive to the patient’s symptoms of remission,less complications.The PTCD has a simple,shorter operation time advantage.In short,for the choice of biliary drainage of severe cholangitis,we need to be based on a variety of drainage methods and the patient’s condition to select the most appropriate program.