重症急性胆管炎合并多器官功能不全综合征的内镜治疗时机的探讨

Timing of endoscopic treatment for acute cholangitis of severe type accompanying multiple organ dysfunction syndrome

目的探讨多器官功能不全综合征（multiple organ dysfunction syndrome，MODS）阶段的重症急性胆管炎（acute cholangitis severe type，ACST）的内镜治疗时机。方法在采取常规吸氧、抗休克等内科治疗措施稳定生命体征的基础上，对9例进入MODS阶段的ACST行内镜下逆行胰胆管造影术、十二指肠乳头括约肌切开术或电针开窗术、网篮取石术、鼻胆管引流术或胆管内支架引流术。结果9例均于35min内顺利完成内镜治疗，7例进入多器官功能不全临床第1和2阶段于术后1—2周内恢复，2例已进入临床第3阶段于术后2周内死亡。结论对于尚未进入多器官功能不全临床第3阶段的重ACST应尽早行内镜下治疗，对于已经进入多器官功能不全临床第3或第4阶段的病人应以控制器官衰竭、恢复器官功能为主。

Objective To investigate the timing of endoseopie treatment for acute eholangitis of severe type （ACST） accompanying multiple organ dysfunction syndrome （MODS）. Methods On the basis of routine medical measures, such as oxygen inhalation and antishoek treatment, 9 patients with ACST accompanying MODS were given endoscopic retrograde eholangiopanereatography （ERCP） with endoscopic sphineterotomy （EST）, or endoscopic nasobiliary drainage （ENBD） after needle electrode fenestration and stone removal with basket, or endoscopic retrograde biliary drainage （ERBD） with internal stent. Results The endoscopic treatment was successfully accomplished within 35 min in all the 9 patients. Seven patients at stage 1 - 2 of MODS rehabilitated at 1 - 2 weeks after treatment, while 2 patients at stage 3 of MODS died in 2 weeks. Conclusions Endoscopic treatment should be applied to patients with ACST at stage 1 - 2 of MODS as early as possible. For patients with ACST at stage 3 -4 of MODS, however, emphasis should be laid on the prevention of organ failure and the reversion of organ functions.