Efficacy of ultrasound-guided percutaneous transhepatic biliary drainage for acute obstructive suppurative cholangitis combined with septic shock

Meng, Miao; Feng, Hui; Tang, Shuan; Peng, Xiaobin

doi:10.1016/j.clinsp.2023.100258

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Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100258 copy

Efficacy of ultrasound-guided percutaneous transhepatic biliary drainage for acute obstructive suppurative cholangitis combined with septic shock

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Ultrasound-guided PTCD improves treatment effect for AOSC combined with septic shock.
Ultrasound-guided PTCD reduces stress response for AOSC combined with septic shock.
Ultrasound-guided PTCD assists patients smoothly to pass preoperative critical period.

Abstract

Objectives

This study aimed to investigate the efficacy of ultrasound-guided Percutaneous Transhepatic Biliary Drainage (PTCD) for the treatment of Acute Obstructive Suppurative Cholangitis (AOSC) combined with septic shock due to choledocholithiasis, and its effect on inflammatory factors.

Methods

Clinical data of 86 patients with AOSC and septic shock admitted to our hospital between January 2019 and May 2021 were retrospectively analyzed and grouped according to different treatment methods. Among them, 43 patients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Nasobiliary Drainage (ENBD) were included in the Control Group (CNG), and 43 patients who underwent ultrasound-guided PTCD were included in the Study Group (SG).

Results

The total effective rate in the SG (88.37%) was higher than that in the CNG (69.77%) (p <0.05); after surgery, the serum inflammatory factors PCT, IL-6, TNF-α, CRP levels, liver function indicators such as TBIL, DBIL, AST, ALT levels, and stress response indicators including NPY, PGE2, 5-HT levels were reduced, and were lower in the SG than in the CNG (p <0.05); postoperatively, CD3+, CD4+, and CD4+/CD8+ levels in the CNG were significantly lower than those before surgery (p <0.05); Postoperatively, CD3+, CD4+, and CD4+/CD8+ levels in the SG were significantly higher than those in the CNG (p <0.05); and the complication rate in the SG (6.98%) was lower than that in the CNG (25.58%) (p <0.05).

Conclusions

Ultrasound-guided PTCD for AOSC combined with septic shock can facilitate the recovery of liver and immune functions with a low complication rate.

Keywords
PTCD; AOSC; Septic shock; Inflammatory factors

Group	n	Operative time (min)	Intraoperative blood loss (mL)	Duration of fever (d)	Duration of Chills (d)	Duration of Abdominal pain (d)	Duration of indwelling drainage tube (d)
Study group	43	95.46 ± 9.47	28.64 ± 2.75	2.07 ± 0.20	1.76 ± 0.17	7.64 ± 0.75	8.73 ± 0.84
Control group	43	118.61 ± 11.86	49.52 ± 4.91	2.46 ± 0.23	1.98 ± 0.18	8.95 ± 0.89	10.62 ± 1.05
T		10.002	24.330	8.391	5.827	7.381	9.217
p		0.000	0.000	0.000	0.000	0.000	0.000

Group	n	Cure	Markedly effective	Effective	Ineffective	Total effective rate
Study group	43	12 (27.91)	20 (46.51)	6 (13.95)	5 (11.63)	38 (88.37)
Control group	43	7 (16.28)	14 (32.56)	9 (20.93)	13 (30.23)	30 (69.77)
χ²						4.444
p						0.035

Group	n	CD3+ (%)		CD4+ (%)		CD4+/CD8+
Group	n	Preoperative	Postoperative	Preoperative	Postoperative	Pre-operative	Postoperative
Study group	43	65.12 ± 6.48	62.84 ± 6.28	39.23 ± 3.90	37.96 ± 3.79	1.62 ± 0.16	1.56 ± 0.15
Control group	43	65.34 ± 6.50	57.71 ± 5.42^a	39.18 ± 3.87	34.52 ± 3.43^a	1.63 ± 0.16	1.47 ± 0.14^a
T		0.157	4.055	0.060	4.413	0.290	2.876
P		0.876	0.000	0.953	0.000	0.773	0.005

Group	n	Incisional infection	Trocar obstruction	Acute pancreatitis	Biliary fistula	Gastrointestinal bleeding	Total
Study group	43	1 (2.33)	1 (2.33)	0	0	1 (2.33)	3 (6.98)
Control group	43	3 (6.98)	2 (4.65)	1 (2.33)	2 (4.65)	3 (6.98)	11 (25.58)
χ²							4.132
p							0.042

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

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[1] * Corresponding author. E-mail address:pengxiaobin61@163.com (X. Peng).