重症急性胆管炎患者内镜治疗与外科手术治疗效果比较

A comparative study between surgical therapy and the endoscopic therapy for patients with acute cholangitis of severe type

目的比较重症急性胆管炎(ACST)患者内镜治疗与外科手术治疗的临床效果,探讨较佳的治疗方法。方法回顾性分析1993年1月至2008年1月间收治的ACST126例患者的临床资料,其中外科手术组67例,内镜组59例,2组一般资料具有可比性。分别比较2组的治愈率、病死率、并发症发生率、胆道引流时间及住院时间。结果临床治愈共109例。手术组及内镜组的临床治愈率分别为83.6%、93.2%,病死率分别为16.4%、6.8%,并发症发生率分别为35.8%、13.6%(P<0.01),胆道平均引流时间分别为34.2、16.8d,平均住院时间分别为42.2、20.6d。结论ACST内镜治疗效果明显优于外科手术治疗,内镜治疗具有操作时间短、创伤小、疗程短的优点,是ACST患者的首选治疗方法。

Objective To compare the therapeutic effects between the surgical therapy and the endoscopic therapy for patients with acute cholangitis of severe type（ACST）.Methods Data of 126 patients with ACST underwent surgical therapy （ST group,n=67）or endoscopic therapy （ET group,n=59） from January 1993 to January 2008 were retrospectively analyzed.The baseline data of two groups were balanced.The cure rate,mortality,rate of complication,duration of biliary tract drainage and time of hospitalization were compared.Results Of 126 cases,109 were cured.The cure rates were 83.6% and 93.2% in ST group and ET group respectively;the mortality was 16.4% and 6.8% in ST group and ET group respectively;the rates of complication were 35.8% and 13.6% in ST group and ET group respectively;the average duration of biliary tract drainage was 34.2 days and 16.8 days in ST group and ET group respectively;the time of hospitalization was 42.2 days and 20.6 days in ST group and ET group respectively.Conclusions The outcome of ET is superior to ST. ET has advantages of shorter operation time,smaller trauma and shorter treatment duration. ET might be the first choice for patients with ACST.