Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

Anhong ZHANG; Ruixin ZHANG; jie MA; Bo QIU; Xin YI; Zhihua LU; Lijie ZHENG; Hanguang DONG; Tian HAN; Li ZHANG; Yuanhui JIANG; Jun XU

doi:10.3969/j.issn.1001-5256.2022.11.020

Volume 38 Issue 11

Nov. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(11): 2542-2545

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Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

DOI: 10.3969/j.issn.1001-5256.2022.11.020

Anhong ZHANG^{1, 2},
Ruixin ZHANG^3a,
jie MA²,
Bo QIU²,
Xin YI²,
Zhihua LU²,
Lijie ZHENG²,
Hanguang DONG²,
Tian HAN^3b,
Li ZHANG¹,
Yuanhui JIANG^{2
,
,
,},
Jun XU^{1
,
,
,}

1.
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant Center, The First Hospital of Shanxi Medical University, Taiyuan 030000, China
2.
Department of General Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, China
3a.
School of Basic Medicine, Shanxi Medical University, Taiyuan 030000, China
3b.
The First Clinical Medical College, Shanxi Medical University, Taiyuan 030000, China

Research funding:

Local Special Projects Guided by the Central Government of Shanxi Province (YDZJSX2021B012)

More Information

Corresponding author: JIANG Yuanhui, jyh2@sina.com (ORCID: 0000-0002-1102-3481); XU Jun, junxuty@163.com (ORCID: 0000-0003-3755-9660)
Received Date: 2022-04-10
Accepted Date: 2022-05-30
Published Date: 2022-11-20

Abstract

Abstract

Objective To summarize the preliminary application results of ultrasound-guided biliary drainage tube replacement, present the corresponding technical points, and discuss the operation strategy and clinical application value. Methods The clinical data of 60 patients who underwent ultrasound-guided biliary drainage tube replacement in Qilu Hospital of Shandong University between August 2014 and August 2020 were retrospectively analyzed. The operation procedure, clinical applications, and postoperative complications were summarized and analyzed. Results Fifty-eight of the 60 patients (96.67%) were successfully replaced with drainage tubes along the original sinus. Among them, dilated sinus tracts of 47 patients were placed with coarse-grade drainage tubes, and dilated sinus tracts of the remaining 11 patients were placed with the original type of drainage tubes, with the mean operation time of 15.8(12.0-19.0) min under local anesthesia. In total, bile was drained from 28 patients receiving PTCD drainage, 23 patients receiving gallbladder drainage, and 9 patients receiving T-tube drainage. The post-operation evaluation revealed that the drainage situation has improved, with a 100% effective rate. No obvious abnormality was found in the postoperative follow-up visit. Conclusion The replacement of drainage tube under ultrasound guidance is simple, safe and feasible, and it provides further promotion in clinical practice with sufficient data support.
- Ultrasonography, Interventional,
- Biliary Tract Surgical Procedures,
- Drainage,
- Punctures,
- Drainage Tube

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急性胰腺炎(acute pamcreatitis，AP)是临床常见消化系统急腹症之一^[1]，近年来，其发病率不断上升^[2]。Yokoe等^[3]研究显示，15%~20%的AP进展为重症急性胰腺炎(severe acute pancreatic, SAP)。脓毒症是病原微生物侵入血液引起的全身感染性疾病，据Sagana等^[4]报道美国每年约有0.6%的人发生脓毒症。SAP病情凶险极易引发脓毒症，SAP一旦发生脓毒症不仅加重医疗费用负担、延长住院时间，还可能并发脓毒性休克，多器官功能障碍，病情进展甚至会引起死亡^[5]，临床诊治极为困难。本研究回顾性分析SAP患者的临床资料，分析SAP患者并发脓毒症的相关因素，旨在为临床防治提供参考。

1. 资料与方法

1.1 研究对象

收集2007年1月—2020年3月贵州医科大学第三附属医院与黔南州人民医院收治的SAP患者临床资料。SAP诊断标准参考中华医学会制定的《急性胰腺炎诊治指南(2014)》^[6]。脓毒症诊断标准参照国家卫生健康委颁发的《医院感染诊断标准(试行)》^[7]。纳入标准：(1)年龄≥16周岁；(2)符合SAP诊断。剔除标准：(1)病历记录不全；(2)伴有恶性肿瘤晚期或使用糖皮质激素患者；(3)入院手术前已合并脓毒症者；(4)伴有其他部位原发性感染者。

1.2 研究方法

根据SAP是否发生脓毒症分为脓毒症与非脓毒症，记录每例患者年龄、性别、APACHEⅡ评分、血糖、血钙、血清总胆固醇、血清甘油三酯、血尿素氮、血清白蛋白、血清肌酐、胰腺坏死范围所占比例，以及入住ICU、低氧血症、深静脉置管、机械通气、预防性使用抗生素、血液净化、手术病灶坏死组织清除方式、留置导尿情况，血培养检出病原菌种类等临床资料。本研究所纳入SAP患者采取急诊手术清除病灶坏死组织，手术方式分为开腹与腹腔镜两种方式。

1.3 伦理学审查

本研究通过贵州医科大学第三附属医院伦理委员会审批，批号：2020-002，并经患者及家属知情同意。

1.4 统计学方法

采用SPSS 24.0软件进行数据分析。计量资料以x±s表示，两组间比较采用t检验，计数资料两组间比较采用χ²检验。多因素分析采用logistic回归分析。P < 0.05为差异有统计学意义。

2. 结果

2.1 一般资料

研究共纳入SAP患者178例，其中男106例、女72例, 年龄16~77岁，平均(49.69±14.77) 岁。发生脓毒症56例(31.46%)，其中男36例、女20例，平均(51.29±13.92)岁。

2.2 脓毒症菌种分布

在56例SAP并发脓毒症患者血培养中共分离出61株病原菌，其中革兰阳性菌14株，占22.95%，革兰阴性菌39株，占63.93%，真菌8株，占13.11%(表 1)。

表 1 SAP合并脓毒症患者的菌种构成比

病原菌	株数(n=61)	构成比(%)
革兰阳性菌	14	22.95
表皮葡萄球菌	8	13.11
溶血葡萄球菌	4	6.56
粪肠球菌	2	3.28
革兰阴性菌	39	63.93
肺炎克雷伯菌	11	18.03
鲍曼不动杆菌	9	14.75
铜绿假单胞菌	9	14.75
大肠埃希菌	7	11.48
嗜麦芽窄食假单胞菌	2	3.28
阴沟肠杆菌	1	1.64
真菌	8	13.11
白色假丝酵母菌	5	8.20
光滑假丝酵母菌	2	3.28
热带假丝酵母菌	1	1.64

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2.2 单因素分析

单因素分析显示，APACHEⅡ评分、血糖、血钙、血清总胆固醇、血清甘油三酯、血尿素氮、血清肌酐、血清白蛋白，以及入住ICU、低氧血症、深静脉置管、机械通气、手术方式、血液净化、留置导尿、胰腺坏死范围在脓毒症和非脓毒症患者间差异均有统计学意义(P值均 < 0.05)(表 2)。

表 2 SAP并发脓毒症的单因素分析

因素	非脓毒症(n=122)	脓毒症(n=56)	统计值	P值
年龄(岁)	48.95±15.14	51.29±13.92	t=1.011	0.314
男/女(例)	70/52	36/20	χ²=0.761	0.383
APACHEⅡ评分(分)	24.35±5.86	27.71±5.56	t=3.683	< 0.001
入住ICU(例)	41	31	χ²=7.538	0.006
低氧血症(例)	36	31	χ²=10.926	0.001
深静脉置管(例)	82	46	χ²=4.235	0.040
机械通气(例)	44	30	χ²=4.842	0.028
血糖(mmol/L)	11.37±3.80	13.13±4.34	t=2.596	0.011
预防性使用抗生素(例)	51	21	χ²=0.295	0.587
手术方式(例)			χ²=8.249	0.004
腹腔镜	43	8
开腹	79	48
血液净化(例)	83	29	χ²=4.343	0.037
留置导尿(例)	34	34	χ²=17.539	< 0.001
胰腺坏死范围(例)			χ²=13.386	0.001
>50%	9	12
30%~50%	39	25
< 30%	74	19
血钙(mmol/L)	2.26±0.32	2.14±0.33	t=-2.144	0.034
血清总胆固醇(mmol/L)	6.13±2.26	7.03±2.20	t=2.498	0.014
血清甘油三酯(mmol/L)	2.02±1.12	2.59±1.23	t=2.946	0.004
血尿素氮(mmol/L)	7.13±2.52	9.05±4.56	t=2.951	0.004
血清肌酐(μmol/L)	116.46±46.78	147.87±67.31	t=3.160	0.002
血清白蛋白(g/L)	36.08±7.95	32.62±10.22	t=-2.246	0.027

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2.3 多因素分析

将单因素分析中有统计学意义的指标纳入logistic多因素回归分析，结果显示，APACHEⅡ评分、低氧血症、血糖、胰腺坏死范围、血清肌酐是SAP并发脓毒症的独立危险因素，采用腹腔镜清除病灶坏死组织为SAP并发脓毒症的独立保护因素(P值均 < 0.05)(表 3)。

表 3 SAP并发脓毒症的多因素分析

变量	B	SE	Wald	P值	OR	95%CI
APACHEⅡ评分(分)	1.909	0.574	11.063	0.001	6.748	2.191~20.788
入住ICU	0.994	0.652	2.321	0.128	2.701	0.752~9.700
低氧血症	1.219	0.568	4.607	0.032	3.383	1.112~10.293
深静脉置管	0.577	0.677	0.728	0.394	1.781	0.473~6.710
机械通气	0.750	0.560	1.794	0.180	2.118	0.706~6.350
血糖(mmol/L)	1.665	0.767	4.714	0.030	5.288	1.176~23.781
手术方式(腹腔镜)	-1.387	0.682	4.133	0.042	0.250	0.066~0.951
血液净化	-0.185	0.554	0.112	0.738	0.831	0.280~2.463
留置导尿	0.636	0.559	1.293	0.256	1.889	0.631~5.651
胰腺坏死范围	1.709	0.640	7.130	0.008	5.523	1.575~19.360
血钙(mmol/L)	-0.964	0.586	2.710	0.100	0.381	0.121~1.202
血清总胆固醇(mmol/L)	0.498	0.593	0.703	0.402	1.645	0.514~5.263
血清甘油三酯(mmol/L)	0.740	0.840	0.777	0.378	2.097	0.404~10.880
血尿素氮(mmol/L)	1.066	0.630	2.862	0.091	2.903	0.845~9.977
血清肌酐(μmol/L)	1.612	0.671	5.771	0.016	5.012	1.345~18.672
血清白蛋白(g/L)	-0.719	0.705	1.041	0.308	0.487	0.122~1.939

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3. 讨论

SAP是常见消化系统急症，后期继发感染性胰腺坏死的概率较高^[8-9]。脓毒症是SAP的严重并发症之一，也是患者后期死亡的重要原因。本研究显示，在178例SAP患者中发生脓毒症56例(31.46%)，与陈莎燕等^[10]报道结果相近，提示SAP患者并发脓毒症的概率较高，直接影响治疗的预后，临床应予以注意。本研究在56例SAP并发脓毒症患者血培养中共分离出61株病原菌，其中革兰阳性球菌14株，占22.95%，革兰阴性杆菌39株，占63.93%，真菌8株，占13.11%，与廖全凤等^[11]研究结果相似，临床应根据其感染病原菌特点选用抗菌药物。

APACHE-Ⅱ评分是判断SAP严重程度与预后的重要评分系统，评分越高提示病情越严重，免疫功能越差，病原菌越易进入血液形成脓毒症^[12]；SAP胰腺组织灌注不足，此时合并低氧血症可增加胰腺组织缺氧程度与坏死范围，导致胰腺感染增加并侵入血流^[13]，同时SAP常伴发肺部感染等胰腺外感染，后者又可加重SAP患者的感染严重程度，严重者引起低氧血症与呼吸功能衰竭，甚至发生多器官功能衰竭风险^[14]；胰腺的内分泌部分泌的胰岛素是调节血糖的重要激素，SAP胰腺坏死损伤胰岛导致胰岛素分泌不足，糖代谢紊乱，血糖升高，有利于病原菌入侵，同时其免疫功能下降，更利于病原菌入侵血流，增加脓毒症的发生^[15]。肌酐是肌肉代谢产物, 肌肉中肌酸通过非酶脱水反应产生，再释放进入血液中，随尿排出体外。因此血清肌酐与人体肌肉总量密切相关，而不易受饮食等影响；再加上肌酐为小分子物质，通过肾小球滤过，很少被肾小管吸收，每日体内产生量几乎均随尿排出，不受尿量影响，因此，临床上将血清肌酐作为肾功能重要指标之一，血清肌酐升高提示肾功能受损^[16]；本研究显示，血清肌酐与脓毒症密切相关，可能原因为肾功能不全时白细胞趋化性功能受损，淋巴细胞功能障碍，体内免疫球蛋白降低，免疫功能下降，容易发生脓毒症^[17-18]。手术病灶清除引流是治疗感染性胰腺坏死的重要手段^[19]；感染性胰腺坏死病灶清除引流手术的方式有开腹与微创手术两种，手术可清除炎性病灶减少感染，但是开放手术创伤大，可引起坏死炎性胰腺组织扩散，感染病原菌侵入血流，同时开腹手术破坏人体自然屏障，外界环境中的病原菌也易通过切口侵入引起脓毒症^[20]，而微创手术方式既可清除炎性坏死组织，又可减少外界病原菌侵入，可减少脓毒症^[21]。胰腺坏死程度越高提示感染性胰腺坏死病灶越大，产生的炎性坏死组织越多，对周围组织破坏也越大，病原菌越易侵入血流产生胰外感染^[22]。多因素分析显示，APACHEⅡ评分、低氧血症、血糖、胰腺坏死程度高、血清肌酐等因素是SAP并发脓毒症的独立危险因素，采用微创手术方式清除病灶坏死组织为SAP并发脓毒症的独立保护因素。

总之，SAP并发脓毒症与多因素相关。控制血糖，保护肺肾等重器官功能，采用微创手术方式清除病灶坏死组织，注意重症、胰腺坏死程度高患者的救治是减少SAP并发脓毒症的重要措施。

References(12)

References

[1]	YANG DX, ZHANG Y, WANG XF, et al. Application of ultrasound-guided real time percutaneous transhepatic cholangial or transhepatic cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals[J]. J Clin Hepatol, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027. 杨东晓, 张勇, 王雪峰, 等. 超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术治疗急性梗阻性胆管炎在基层医院的应用[J]. 临床肝胆病杂志, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027.
[2]	HE YT, XIE LD, ZHOU HP, et al. Application of ultrasound-guided percutaneous transhepatic bile duct drainage in 100 cases[J]. Chin J Prim Med Pharm, 2019, 26(18): 2235-2238. DOI: 10.3760/cma.j.issn.1008-6706.2019.18.014. 何颖韬, 谢丽丹, 周海萍, 等. 超声引导经皮经肝穿刺胆管引流术100例应用观察[J]. 中国基层医药, 2019, 26(18): 2235-2238. DOI: 10.3760/cma.j.issn.1008-6706.2019.18.014.
[3]	GIURAZZA F, CORVINO F, CONTEGIACOMO A, et al. Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage: a multicenter experience[J]. J Ultrasound, 2019, 22(4): 437-445. DOI: 10.1007/s40477-019-00399-w.
[4]	ZHAO KY, ZHANG K, WANG S, et al. Advances in endoscopic ultrasound-guided gallbladder interventional therapy[J]. Chin J Med Offic, 2020, 48(12): 1503-1506. DOI: 10.16680/j.1671-3826.2020.12.44. 赵凯越, 张凯, 王晟, 等. 超声内镜引导下胆囊介入治疗研究进展[J]. 临床军医杂志, 2020, 48(12): 1503-1506. DOI: 10.16680/j.1671-3826.2020.12.44.
[5]	SUN WB. Preventive strategies of bile duct injury in emergent laparoscopic operations for severe acute cholecystitis[J]. Chin J Hepatobiliary Surg, 2016, 22(7): 433-436. DOI: 10.3760/cma.j.issn.1007-8118.2016.07.001. 孙文兵. 重度急性胆囊炎急诊腹腔镜手术时的胆管损伤的预防策略[J]. 中华肝胆外科杂志, 2016, 22(7): 433-436. DOI: 10.3760/cma.j.issn.1007-8118.2016.07.001.
[6]	LI CL, ZOU SH, YI GX, et al. Percutaneous transhepatic cholangiodrainage under ultrasonic and X-ray guidance for malignant obstructive jaundice[J]. Chin J Gen Surg, 2015, 24(2): 185-189. DOI: 10.3978/j.issn.1005-6947.2015.02.006. 李春雷, 邹盛海, 易广新, 等. 超声定位联合X线引导下经皮经肝穿刺胆管引流术治疗恶性梗阻性黄疸[J]. 中国普通外科杂志, 2015, 24(2): 185-189. DOI: 10.3978/j.issn.1005-6947.2015.02.006.
[7]	YU DJ, REN WZ, YUE ZY, et al. Ultrasound guided percutaneous transhepatic biliary drainage: an analysis of 479 patients[J]. Chin J Hepatobiliary Surg, 2018, 24(2): 83-86. DOI: 10.3760/cma.j.issn.1007-8118.2018.02.003. 于德江, 任为正, 岳振宇, 等. 超声引导下经皮肝内胆管穿刺置管引流479例分析[J]. 中华肝胆外科杂志, 2018, 24(2): 83-86. DOI: 10.3760/cma.j.issn.1007-8118.2018.02.003.
[8]	HAN JZ, TUO HF, WANG ZP, et al. Research advances in percutaneous cholecystostomy in treatment of acute cholecystitis[J]. J Clin Hepatol, 2021, 37(8): 1983-1987. DOI: 10.3969/j.issn. 1001-5256.2021.08.052. 韩景钊, 脱红芳, 王泽普, 等. 经皮胆囊造瘘术治疗急性胆囊炎的研究进展[J]. 临床肝胆病杂志, 2021, 37(8): 1983-1987. DOI: 10.3969/j.issn. 1001-5256.2021.08.052.
[9]	XIE F, ZHU F, WANG HY, et al. Clinical application of percutaneous gallbladder drainage in severe acute pancreatitis[J]. J China Med Univ, 2018, 3: 244-246. DOI: 10.12007/j.issn.0258-4646.2018.03.012. 谢锋, 朱芳, 王红岩, 等. 经皮胆囊穿刺引流术辅助治疗重症急性胰腺炎的临床应用价值[J]. 中国医科大学学报, 2018, 3: 244-246. DOI: 10.12007/j.issn.0258-4646.2018.03.012.
[10]	OGURA T, TAKAGI W, KURISU Y, et al. Technical tips for peroral transluminal cholangioscopy using novel single-operator cholangioscope (with videos)[J]. J Hepatobiliary Pancreat Sci, 2016, 23(10): E25-E29. DOI: 10.1002/jhbp.380.
[11]	BELAND MD, PATEL L, AHN SH, et al. Image-guided cholecystostomy tube placement: short- and long-term outcomes of transhepatic versus transperitoneal placement[J]. AJR Am J Roentgenol, 2019, 212(1): 201-204. DOI: 10.2214/AJR.18.19669.
[12]	GUPTA P, MARALAKUNTE M, KALRA N, et al. Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis[J]. Abdom Radiol (NY), 2021, 46(5): 2156-2160. DOI: 10.1007/s00261-020-02825-8.

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Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

DOI: 10.3969/j.issn.1001-5256.2022.11.020