【摘要】 目的总结急性化脓性胆管炎患者内镜介入治疗的效果。方法对该院2002年6月～2007年7月收治的急性化脓性胆管炎经内镜介入治疗的31例患者的临床资料进行回顾性分析。结果全部患者均成功放置ENBD或ERBD,其中12例单枚结石和结石嵌顿于乳头,行EST和电针开窗后直接取净结石,痊愈出院。单纯放置ENBD13例,放置胆管内置管6例。8例胆管多发结石待胆管炎和全身情况缓解后再次内镜治疗,取净结石后痊愈,3例胆管多发结石内镜取石失败,行常规手术,带T管痊愈出院。1例胆道良性狭窄患者1年内更换3次塑料支架后痊愈。1例胆总管癌,1例十二指肠乳头癌,1例胰头癌患者全身情况改善后行手术治疗,术后近期效果良好。1例肝门胆管癌患者,建立胆道引流后,休克、毒血症症状无法改善死亡。1例肝门胆管癌ENBD外引流后,胆管炎缓解,但黄疸消退不明显,再次行左右肝管双支架置入,黄疸好转。结论急性化脓性胆管炎一旦诊断明确,内镜介入治疗可以在最短的时间内改善患者的全身状况。只有尽早选择适当的内镜介入治疗方法,才能在最大程度上提高治愈率,挽救患者生命。更多还原

【Abstract】 【Objective】To review the curative effect of minimally invasive intervention on the patients with acute suppurative cholangitis (ASC). 【Methods】31 patients with acute suppurative cholangitis between June 2002 to July 2007 were chosen and performed with endoscopic therapy. Then the clinical data were retrospectively analyzed. 【Results】All patients were treated successfully with endoscopic nasobiliary drainage (ENBD) or endoscopic retro- grade biliary drainage (ERBD). A single stone was incarcerated in the duodenal nipple in 12 patients. The stone was removed with endoscopic sphineterotomy (EST) and needle electrode fenestration. 13 patients were treated with ENBD, 6 patients were treated with endobiliary drainage. 8 patients with multiple biliary calculi were performed ef- fectively with endoscopic therapy after cholangitis and general situation turned better. 3 patients with multiple biliary calculi failed in endoscopic therapy, then were treated with conventional surgery, recovered and discharged with T- tube unremoved. One patient with biliary benign stricture recovered after replacing plastic stent three times in one year. The recent prognosis is excellent with operative treatment after improving the general situation in one patient with choledochal cancer, one patient with papillary carcinoma of the duodenum, one patient with pancreatic head cancer. One patient with hepatic hilar cholangiocarcinoma died of toxaemia and shock after establishing biliary drainage. One patient with hepatic hilar cholangiocarcinoma reduced jaundice after the left and right hepatic duct stent implantation in second treatment, and the first treatment with ENBD only make cholangitis better. 【Conclutions】 The general situation of patients will turn better in the shortest time by endoscopic therapy after clear diag- nosis. Appropriate endoscopic interventional treatment adopted in the early time is the only way to improve the cure rate to the greatest extent and save the patient′s life.更多还原