重症急性胆管炎的急诊内镜治疗(附156例报告)

Emergency endoscopic treatment for acute cholangitis of severe type:report of 156 cases.

目的 探讨内镜在重症急性胆管炎 (ACST)急诊治疗中的应用价值。方法 自 1997年 1月至 2 0 0 2年 5月应用十二指肠镜急诊治疗重症急性胆管炎。对于乳头部结石嵌顿用针型刀切开乳头、插管困难者先行乳头括约肌切开术。选择直径 <1 2cm的 1～ 2颗胆总管结石行经内镜括约肌切开术 (EST) ,网篮取石放置鼻胆引流管 (ENBD) ,其余直接行鼻胆引流管引流。结果 15 6例ACST中 14 8例ENBD治疗成功 ,内镜治疗成功率94 9%。 12 5例ENBD治疗后 2 4小时内症状减轻。所有良性病变 (胆总管结石、胆管良性狭窄 )均得到有效引流 ,5例胆道恶性肿瘤由于胆管的多处狭窄引流失败。平均引流时间为 7 3天 (1～ 2 5天 )。无一例消化道穿孔和死亡 ,术后 5例出现急性轻型胰腺炎 ,3例乳头出血 ,总的并发症发生率 5 1%。结论 急诊内镜治疗ACST操作简便 ,安全有效 ,尤其适用于高龄、一般情况较差。

Objective To assess the value of emergency endoscopic treatment for acute cholangitis of severe type (ACST).Methods Emergency treatment with duodenoscopy was indicated for ACST between January 1997 and May 2002 As for stone fitted in papillary orifice, a needle-knife was introduced to cut papilla. When deep cannulation of the common bile duct (CBD) was difficult, a small endoscopic sphincterotomy (EST) was performed. Those with one or two stones (diameter less than 1 2cm) in the CBD were given EST selectively and a nasobiliary catheter was inserted after stones were excluded by basket. Others received endoscopic nasobiliary drainage (ENBD) directly. Results Of 156 patients with ACST, 148 were given ENBD. The successful rate of emergency endoscopic treatment was 94 9%. The acute cholangitis subsided within 24 hours in 125 patients. All patients with benign causes (choledocholithiasis or benign stricture) achieved effective drainage after ENBD. On the other hand, ENBD failed to improve cholangitis in 5 patients due to multiple biliary strictures. The duration of drainage was 7 3 days (range,1～25 days). There was no digestive tract perforation and death in this study. Total complications were noted in 8 cases (5 1%). 5 patients developed mild acute pancreatitis and papillary hemorrhage occurred in 3 patients. Conclusion Emergency endoscopic treatment is simple, safe and effective for ACST, particularly for eldly or critically ill patients, as well as for those with coagulopathy, liver cirrhosis or many previous biliary operations.