个体化治疗老年急性梗阻性化脓性胆管炎患者的临床研究

Clinical studies on individual therapy for acute suppurative cholangitis in aged patients

目的比较经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+十二指肠乳头括约肌切开术(endoscopic nasobiliary drainage,ENBD)+经内镜鼻胆管引流术(endoscopic sphincterotomy,EST)和经皮经肝胆管引流术(percutaneous transhepatic cholangial drainage,PTCD)对急性梗阻性化脓性胆管炎(acute obstructive suppurative cholangitis,AOSC)患者的治疗效果,为临床治疗AOSC手术方式的选择提供依据。方法回顾性分析2009年12月至2014年1月间,共93例老年急性梗阻性化脓性胆管炎患者临床资料,其中ERCP+EST+ENBD(A组)42例,PTCD(B组)51例,对比2种方法临床治疗效果。结果 93例患者均成功施行介入术及内镜治疗,PTCD耐受性更好,引流效果更确切,ERCP+EST+ENBD在控制性损伤最小化的前提下提供了解决胆管结石梗阻的方案。结论 PTCD用于治疗AOSC,成功率较高,引流效果可靠,能充分降低胆道压力,降低风险,为二期手术治疗创造了机会和条件,ERCP+EST+ENBD在微创的前提下提供了解决结石梗阻的机会。

Objective To compare endoscopic retrograde cholangio-pancreatography（ERCP） ＋ endoscopic sphincterotomy（EST）＋ endoscopic nasobiliary drainage（ENBD） and percutaneous transhepatic cholangial drainage（PTCD） operation for acute obstructive suppurative cholangitis（AOSC） in aged patients with the treatment effect,and provide the basis for the treatment of AOSC operation mode selection.Methods Retrospective analysis of 93 patients with acute obstructive suppurative cholangitis in patients with clinical data of our hospital from December 2009 to January 2014,including ERCP ＋ EST ＋ ENBD（A group） 42 cases,PTCD 51 cases（B group）,compared with the 2 methods of treatment effect.Results Totally 93 cases had successful intervention and endoscopic therapy,PTCD tolerance better drainage effect more precisely,ERCP ＋ EST ＋ ENBD provides a solution of calculus of bile duct obstruction cases in control of damage is minimized under the premise.Conclusion PTCD for the treatment of AOSC,the success rate is high,the drainage effect is reliable,can fully reduce the pressure of biliary tract,reduce clinical risk,creating opportunities and conditions for the two stage surgical treatment,but the ERCP ＋ EST ＋ ENBD in minimally invasive premise provides a solution for biliary calculi obstruction.