Clinical Characteristics Of Severe Acute Cholangitis And A Comparative Study Of Endoscopic Retrograde Cholangiopancreatography And Percutaneous Transhepatic Cholangio-Drainage Treatment

Objective: To analyze and explore the clinical features of acute cholangitis of severe type(ACST),and to compare the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cholangio-drainage(PTCD)treatment.Methods: Data of 69 patients with ACST treated in Department of Gastroenterology,Department of hepatobiliary surgery and ICU of the First Affiliated Hospital of Guangxi Medical University from January 2014 to May2020 were retrospectively analyzed.Patients were divided into the ERCP group and the PTCD group according to the way of treatment.The general clinical datas,laboratory examination,length of stay,ICU occupancy,complications and prognosis of the two groups were analyzed.Results: There were no significant differences in gender,age,previous biliary surgery history,comorbidities,etiology,preoperative jaundice level,and white blood cell counts between the two groups(P > 0.05).Among the 69 patients,91.3%(63 / 69)had stones.The positive bile culture rate was 68.3%(41 / 60),and there was 48 strains of pathogenic bacteria,among which Escherichia coli accounted for 45.8%(22 / 48).The positive blood culture rate was 44.2%(19 / 43),among which Escherichia coli accounted for 52.6%.WBC of the positive bile culture patients was higher than that of the negative patients,the difference was statistically significant(P < 0.05),and there were no significant differences in NEUT%,PCT and CRP.In 69 cases of ACST patients were accompanied with one or more organ dysfunction,the top three were blood system(PLT < 100 × 109 / L),cardiovascular system(hypotension requires dopamine(≥ 5ug / kg / min)or norepinephrine),and liver function(PT-INR >1.5),accounting for 85.5%,37.7% and 29.0% respectively.The levels of jaundice(TBIL and DBIL),WBC,NEUT%,PCT and CRP in both groups on the third day after operation were significantly improved(P < 0.05).After treatment,ALT,AST,GGT,WBC and NEUT% in the ERCP group was significantly decreased than that in the PTCD group(P < 0.05).There were no significant differences in length of stay,complications,effective rate and mortality between the two groups(P > 0.05).However,the PTCD group had a higher ICU occupancy(38.2% vs 11.4%,P < 0.05)and a lower cure rate compared to the ERCP group(57.1% vs 2.9%,P < 0.05).Conclusion: Stone is the most common cause of ACST.The most common pathogenic bacterium of ACST is Escherichia coli,and the most common organ system disorder is thrombocytopenia.Both ERCP and PTCD are effective treatments of ACST.But ERCP is better than PTCD in improving liver function(ALT,AST,GGT)and reducing WBC and NEUT%.Furthermore,the ICU occupancy of the ERCP group is lower and the cure rate is higher than that of the PTCD group.