A clinical evaluation of CRRT coupled with ultrasound-guided percutaneous transhepatic gallbladder drainage for the treatment of severe acute biliary pancreatitis

Abstract

Objective To investigate the value of continuous renal replacement therapy (CRRT) coupled with minimally invasive ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) for the treatment of severe acute biliary pancreatitis. Methods Hospitalized patients with severe acute biliary pancreatitis were recruited from the intensive care unit (ICU) of the Affiliated Hospital of Qingdao University from June 2010 to June 2015, and divided into conventional CRRT alone group (n = 30) and CRRT + PTGD group (n = 30). Comparisons of postoperatively symptoms (time required for abdominal pain relief, time consumed for, gastrointestinal decompression), laboratory findings (WBC, PLT, PCT, CRP, AMS, TBIL, ALT, ALB, Lac) and acute physiology and chronic health evaluation score (APACHE Ⅱ, Balthazar CT, MODS) were carried out between two groups. The occurrence of complications (ARDS, abdominal infection, bile leakage, abdominal hemorrhage, intestinal injury, catheter translocation, catheter dislocation) was observed. The differences in duration of ventilator support, the length of stay in ICU, and fatality rate were compared between the two groups. Results Compared with the conventional CRRT alone group, the postoperative symptoms were significantly relieved, and time required for abdominal pain relief and time consumed for gastrointestinal decompression were evidently shortened in the CRRT + PTGD group (P < 0.05). There were statistically significant differences in laboratory findings (WBC, PLT, PCT, CRP, AMS, TBIL, ALT) between two groups (P < 0.05). The differences in APACHE Ⅱ, Balthazar CT and MODS score between the two groups also presented statistical significance (P < 0.05). The comparisons of the duration of ventilator support [(6.1 ± 1.3) d vs. (9.5 ± 1.4) d] and the length of stay [(15.7 ± 1.1) d vs. (21.1 ± 2.5) d] between the two groups revealed statistical significance (P < 0.05). Conclusions CRRT coupled with PTGD for the treatment of severe acute biliary pancreatitis can effectively eliminate the inflammatory mediators and toxins from patients. On this basis, the coupled therapy with gallbladder puncture and drainage is capable of decompressing the biliary tract, improving liver function, effectively relieving clinical symptoms, minimizing the changes of laboratory findings and APACHE II score, and thereby optimizing the prognosis of patients. Key words: Pancreatitis; Biliary; CRRT; Ultrasound-guided; Catheter drainage