Clinical Observation Of Early PTGD And ERCP For Severe Acute Biliary Pancreatitis

Objective To investigate the clinical effect of early percutaneous transhepatic gallbladder drainage(PTGD)and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of severe acute biliary pancreatitis(SABP),and to compare the clinical value of the two methods.Methods A retrospective analysis was performed for the clinical data of 69 patients with SABP treated in the People’s Hospital of Liaoning Province from March 2014 to March 2018.According to different treatment methods received in the early stage of the disease,they were divided into three groups: PTGD group(n=22),ERCP group(n=27)and conservative group(n=20).Comparisons of laboratory indexes and clinical scores before and after treatment and the time of laboratory indexes back to normal,disappearance of abdominal pain,body temperature returning to normal,oral feeding,hospitalization were carried out among there groups.And the incidence of complications and mortality in each group were observed.Results 1.Comparison of changes in Laboratory indexes after 3 days of treatment: The Laboratory indexes of WBC,CRP,AMS,TBIL and ALT decreased significantly in the PTGD group and ERCP group compared with the conservative group and thedifferences were Statistically significant(P<0.05);TBIL was significantly different between the ERCP group and the PTGD group at 3 days after surgery(P<0.05).WBC,CRP,AMS,and ALT were not statistically significant(P>0.05).Compared with before and after treatment in each group,the laboratory indexes of PTGD group and ERCP group decreased significantly after 3 days and the differences were statistically significant(P<0.05).In the conservative group,the decrease of AMS was statistically significant(P<0.05).Although the other indicators decreased,they were not statistically significant(P>0.05).2.Comparison of clinical scores after 1 week of treatment: The clinical scores of PTGD group and ERCP group were significantly lower than those of the conservative group,the difference was statistically significant(P<0.05);PTGD Compared with the ERCP group,the scores were not statistically significant(P>0.05).Compared with the treatment of before and after in each group,the APACHE II score and the modified Marshall score decreased significantly in the PTGD group and the ERCP group 1 week after surgery.The difference was statistically significant(P<0.05).But there was no statistically significant decrease in CTSI score(P>0.05).Although the clinical scores of the conservative group decreased,there was no statistical significance(P>0.05).3.Comparison of the recovery time of laboratory indexes: the time of WBC,CRP,AMS,TBIL,ALT returning to normal in PTGD group and ERCP group was shorter than that in conservative group(P < 0.05).The time of TBIL returning to normal in ERCP group was shorter than that in PTGD group,the difference was statistically significant(P < 0.05),but there were no significant difference in WBC,CRP,AMS,ALT(P > 0.05).4.Comparison of clinical symptoms(signs)remission time and hospitalization time:compared with conservative group,PTGD group and ERCP group had shorter time of abdominal pain disappearance,recovery of body temperature,oral feeding time and hospitalization time.The differences were statistically significant(P < 0.05).Compared with PTGD group,the time of oral feeding and hospitalization in ERCP group was shorter than that in PTGD group(P < 0.05).But the time of disappearance ofabdominal pain and the time of body temperature returning to normal were not significant(P > 0.05).5.Incidence of complications during treatment and mortality during first hospitalization in each group: PTGD group,ERCP group compared with conservative group,systemic complications: systemic inflammatory response syndrome(SIRS),multiple organ dysfunction syndrome(MODS),upper gastrointestinal hemorrhage,sepsis and mortality were significantly lower(P < 0.05).Local complications: acute peripancreatic fluid accumulation,acute necrotic accumulation,encapsulated necrosis,pancreatic pseudocyst incidence was similar to the conservative group,and the differences were not statistically significant(P > 0.05).Comparison between ERCP group and PTGD group,the incidence of local and systemic complications and mortality were similar and the differences were not statistically significant(P > 0.05).Conclusion The treatments of early PTGD and ERCP for patients with SABP are beneficial,and there is no significant difference between PTGD and ERCP in the critical outcomes such as complications and mortality.PTGD can be used as an alternative treatment for patients with SABP who have failed to receive ERCP or are unable to tolerate ERCP,which is worthy of clinical promotion.