急性重症型胆管炎的内镜治疗  

Endoscopic treatment for acute intensive cholangitis

作　　者：胡智强 李江宁 

机构地区：[1]湖南省长沙市第三医院普外一科,湖南长沙410015

出　　处：《中国内镜杂志》2013年第5期523-525,共3页China Journal of Endoscopy

摘　　要：目的比较开腹手术和内镜治疗急性重症型胆管炎(ACST)的临床疗效。方法分析该院2004年9月～2012年4月95例急性重症胆管炎患者的临床资料,比较开腹手术和内镜治疗术后死亡率、术后并发症发生率、住院时间和住院费用等指标,并进行统计学分析。结果内镜组中2例多脏器衰竭死亡,死亡率4.4%,开腹组中6例因多器官衰竭死亡,2例感染中毒性休克死亡,1例弥漫性血管内凝血并发严重肾功能衰竭死亡,死亡率18.0%,两组患者术后死亡率比较差异有显著性(P<0.05);内镜组中术后出现并发症5例,发生率12.5%,其中胆道出血2例、胆系感染2例、急性胰腺炎1例;开腹组中出现术后并发症15例,发生率30.0%,其中并发切口感染4例、呼吸衰竭及肺内感染4例、心功能衰竭3例、急性胰腺炎2例、感染性休克2例,两组患者术后并发症比较差异具有显著性(P<0.05);两组患者住院时间及住院费用上差异有显著性(P<0.05)。结论与传统开腹手术相比内镜治疗急性重症型胆管炎具有术后并发症发生率低、死亡率降低、住院时间短、住院费用少的优点。内镜治疗作为治疗重症急症型胆管炎的首选。[Objective] To compare the open operation and endoscopic treatment for acute intensive cholangitis of clinical curative effect. [Methods] 95 cases with acute intensive cholangitis patient clinical data in our hospital between 2004 September to 2012 April were analyzed. The open operation and endoscopic treatment of postoperative mortality, incidence of postoperative complications, hospital stay and hospital costs and other indicators were compared. [Results] Endoscopic group 2 patients died of multiorgan failure, mortality is 4.4%, the open group in 6 cases with multiple organ failed and died, 2 patients with septic shock death, 1 cases of disseminated intravascular coagulation complicating severe renal failure and death, mortality rate of 18%, two groups of patients in postoperative mortality with statistical difference （P 0.05） in the endoscopic group; postoperative complications occurred in 5 cases, the occurrence rate of 12.5%, of which 2 cases of biliary tract hemorrhage, infection of biliary tract in 2 cases, 1 cases of acute pancreatitis; open group with postoperative complications occurred in 15 cases, the occurrence rate of 30%, in which concurrent incision infection in 4 cases, respiratory failure and pulmonary infection in 4 cases, 3 cases of heart failure, acute pancreatitis in 2 cases,2 cases of septic shock, the two groups of patients in the postoperative complications with significant difference（P 0.05）; the two groups of patients in the duration of hospital stay and hospital costs had significant difference （P 0.05）. [Conclusions] Compared with traditional open operation endoscopic treatment for acute intensive cholangitis with a low postoperative complication rate, mortality, shorter hospitalization time, hospitalization costs less. Therefore, we consider endoscopic therapy as a treatment for acute intensive cholangitis preferred type.

关 键 词：急性重症型胆管炎 开腹手术 内镜治疗 

分 类 号：R657.4[医药卫生—外科学]