鼻胆管引流防治经内镜逆行胰胆管造影术后胆管炎的临床研究  

Clinical investigation of ENBD for prevention and treatment of post-ERCP cholangitis

作　　者：吴胜[1,2] 李界明 张伟杰[1,2] 罗昆仑 葛继强[1,2] 

机构地区：[1]解放军第101医院肝胆外科 [2]南京军区腹腔镜外科中心,江苏无锡214044

出　　处：《中国内镜杂志》2010年第7期678-681,共4页China Journal of Endoscopy

摘　　要：目的探讨经内镜鼻胆管引流(ENBD)对于防治内镜逆行胰胆管造影术(ERCP)术后胆管炎的临床应用价值。方法依据6项病例筛选标准,将2003年3月～2008年8月804例行ERCP术的患者随机分成A、B两组,A组(n=421)于术后均行ENBD,B组(n=383)均未行ENBD,比较两组ERCP术后胆管炎的情况。结果 A、B两组患者ERCP术后胆管炎的例数分别为5例(1.2%)、24例(6.3%)。A组中单纯性胆管炎4例,均经非手术治疗痊愈;重症胆管炎(ACST)1例(0.2%),行经皮肝穿刺胆道引流(PTCD)后仍因并发多器官功能衰竭(MOF)而死亡。B组中单纯性胆管炎15例,ACST9例(2.3%),行手术治疗13例,4例(1.0%)出现ACST后并发MOF而死亡。A、B两组间ERCP术后胆管炎发生率比较(χ2=14.878,P<0.01)及ACST发生率比较(χ2=5.667,P=0.017)差异有显著性,死亡率比较(χ2=1.009,P=0.315)差异无显著性。结论 ENBD能有效防治ERCP术后胆管炎,对于存在ERCP术后胆管炎危险因素及年老体弱者尤为必要。【Objective】The aim of this randomized study was to investigate whether endoscopic nasal biliary drainage （ENBD） was necessary after endoscopic retrograte choangiopancreatography （ERCP）.【Methods】From May 2003 to August 2008,804 patients who underwent ERCP were enrolled in this study. Under six criteria,they were randomly divided into group A （n =421）：with ENBD and group B （n =383）：without ENBD.【Results】In group A,5 cases （1.2%） experienced post-ERCP cholangitis,4 of them experienced simple cholangitis,and cured by conserva-tive treatment. One （0.2%） experienced acute cholangitis of severe type （ACST）,in spite of percutaneous transhepatic cholangial drainage （PTCD）,died from multiple organ failure （MOF）. There were 24 cases （6.3%） experienced post-ERCP cholangitis in group B,15 cases experienced simple cholangitis,9 cases （2.3%） experienced ACST. 13 of them treated by operation,4 （1.0%） of them experienced ACST and died from MOF. The post-ERCP cholangits and ACST rates were much higher in group B than that of group A （χ2=14.878,P 0.01 and χ2=5.667,P =0.017）,but the mortality rates between the two groups were no statistical difference （χ2=1.009,P =0.315）.【Conclusion】ENBD can prevent and treat post-ERCP cholangitis effectively,especially for those who had high risk for post-ERCP cholangitis and elderly patients.

关 键 词：鼻胆管引流 经内镜逆行胰胆管造影 胆管炎 并发症 随机对照试验 

分 类 号：R657.3[医药卫生—外科学]