内镜 腹腔镜联合治疗急性重症胆管炎系列性方案研究

Clinical study on serial scheme of combined endoscopy and laparoscopy treatment for acute cholangitis of severe type

目的探讨不同病因所致急性重症胆管炎(ACST)的内镜、腹腔镜及其联合治疗的最佳方法,提出微创治疗急性重症胆管炎的系列性方案。方法自2000年3月至2006年3月天津市南开医院微创外科中心收治急性重症胆管炎病人224例,首先行急诊内镜鼻胆管引流术(ENBD),待病人平稳渡过急性期后,根据不同病因和病情特点实施内镜、腹腔镜及其联合治疗。结果224例ACST病人,急诊内镜成功219例,成功率97.8%,无严重并发症及死亡病例。183例胆管结石中,择期内镜胆管取石治疗122例,成功率95.1%;择期腹腔镜、胆管探查、一期缝合胆管治疗41例,成功率97.6%;择期内镜胆管内支架放置术姑息性治疗胆管结石23例,成功率100%;4例急诊行腹腔镜胆总管探查、T管引流术,成功率100%;胆管狭窄41例中,36例限期行内镜胆管狭窄逐级扩张+胆道内支架放置术;5例实施限期开腹根治手术。结论内镜、腹腔镜联合、分阶段治疗实现了ACST的全程微创化治疗,手术耐受性好,风险低,提高了存活率和病因治愈率。

Objective To study the most appropriate approach to treat Acute cholangitis of severe type （ACST） by endoscopy,laparoscopy and integrated endoscopy and laparoscopy. Methods Two hundreds and twenty-four patients with ACST were received mini-invasive surgical treatment in Tianjin Nankai Hospital from March 2000 to March 2006. The endoscopic nasobiliary drainage （ENBD） was firstly performed. The cases were selected to perform remove pathogeny of ACST by means of endoscopy, laparoscopy or combined them, according to respectively patient＇s individualized conditions after acute-care phase. Results Among 224 ACST patients, urgent ENBD was successfully performed in 219 （97. 8% ）. Among 183 cholelithiasises,selectived endoscopy treated 122 cases,and the success rate was 95.1%. Laparoscopic common bile duct exploration （LCBDE）treated 41 cases, and the success rate was 97. 6%. Twenty-three cases received the scheme of selectived endoscopic retrograde biliary drainage （ ERBD）, and the success rate was 100%. Four cases with common bile duct stones didn＇ t complete treatment of urgent ENBD, who received emergent laparoscopic common bile duct exploration and T-tube drainage, and the success rate was 100%. Among 41 biliary strictures,36 of them accepted endoscopic biliary dilatation and 5 of them accepted open radical operation. Conclusion For patients with ACST, combined endoscopy and laparoscopy treat is safe and effective.