Analysis Of The Efficacy Of Ultrasound-guided Percutaneous Drainage In The Treatment Of Moderate And Severe Acute Cholangitis

Objective: Acute cholangitis(AC)is one of the common clinical critical diseases,often caused by biliary obstruction,acute onset,rapid progress of the disease,prone to septic shock,multiple organ failure(MODS),may be life-threatening,rapid and effective reduction of biliary pressure is the key to treatment.At present,percutaneous transhepatic biliary drainage of(PTCD)and percutaneous transhepatic gallbladder drainage of(PTGD)as the initial biliary decompression treatment for acute cholangitis is still controversial.The purpose of this study is to explore the effectiveness,safety and feasibility of ultrasound-guided PTCD and PTGD as the initial biliary decompression in patients with moderate or severe acute cholangitis,and to provide a reference basis for clinical selection of appropriate drainage methods.Research methods: The clinical data of 158 patients with moderate or severe acute cholangitis treated in the Department of Hepatobiliary and Pancreatic surgery,China-Japan Friendship Hospital of Jilin University from January 2012 to November 2020 were analyzed retrospectively.Percutaneous transhepatic cholangitis or gallbladder drainage was performed under the guidance of color Doppler ultrasound.The success rate of operation,the occurrence of complications,the control of infection,the recovery of liver function and the severity of acute cholangitis were analyzed and discussed.Results: All the patients in the group were successfully placed with catheter under the guidance of ultrasound,with a success rate of 100%.Among them,104 patients received percutaneous transhepatic bile duct drainage(PTCD),54 patients with low bile duct obstruction received percutaneous transhepatic gallbladder drainage(PTGD)because of bile duct dilatation,severe coagulation dysfunction,inability to cooperate(restlessness,etc.),subjective decision of patients and other reasons.Biliary obstruction was significantly relieved after drainage.Compared with before operation,the infection index,liver function,bilirubin and other indexes of the two groups were significantly improved,and the improvement rate was more than 95%,and the difference was statistically significant(P < 0.01).In addition,this study found that both operations could improve the severity of most patients during hospitalization,with improvement rates of 89.4% and 87.0%,respectively.There were 6 patients with postoperative complications during hospitalization in the PTCD group,with an incidence of 5.8%(3 patients with postoperative complications occurred in the 6x104);PTGD group,with an incidence of 5.6%).Among them,4 ases of serious complications occurred in PTCD group,including 2 cases of death,and no puncture-related complications such as bile leakage and pneumothorax occurred in all patients.Conclusion: Ultrasound-guided percutaneous drainage has the advantages of less trauma,high success rate,effective reduction of biliary pressure,rapid relief of symptoms,reduced risk of severe symptoms and low incidence of complications,so it can be used as an initial method of biliary decompression for patients with moderate to severe acute cholangitis.When the treatment of PTCD is limited,PTGD can be used as an effective alternative treatment for moderate to severe acute cholangitis with simple operation and high safety,but it is mainly for patients with low biliary obstruction with gallbladder enlargement.