【作者】 周平红； 姚礼庆； 高卫东； 何国杰； 徐美东； 钟芸诗； 王萍； 秦新裕；

【Author】 ZHOU Ping - hong, YAO Li - qing, GAO Wei - dong, HE Guo -jie,XU Mei - dong,ZHONG Yun - shi, WANG Ping.QIN Xin - yu(Department of General Surgery, Zhongshan Hospital,Fudan University, Shanghai 200032, P. R. China )

【机构】 复旦大学附属中山医院普外科；

【摘要】 目的探讨内镜在急性重症胆管炎(ACST)急诊治疗中的应用价值。方法自1997年1月～2002年5月应用十二指肠镜急诊治疗急性重症胆管炎。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<1.2 cm的1-2颗胆总管结石行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156例ACST,148例ENBD治疗成功,内镜治疗成功率94.9%。125例ENBD治疗后症状24 h内减退。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 d(1～25 d)。无1例消化道穿孔和死亡,术后出现5例急性轻型胰腺炎,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、肝硬化凝血功能障碍和多次胆道手术患者。更多还原

【Abstract】 [Objective]To assess the value of emergency endoscopic treatment for acute cliolangitis of severe type (ACST). [Methods] Emergency treatment with duodenoscope 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. If 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 1.2 cm) 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 cliolangitis subsided within 24 hours of ENBD 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 cliolangitis 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. [Conclusions] Emergency endoscopic treatment is simple, safe and effective for ACST, particularly for eldly or critically ill patients, as well as for those with co agulopathy, liver cirrhosis or many previous biliary operations.更多还原