内镜逆行胰胆管造影术在高龄急性胆囊炎患者中的应用  

Clinical Application of ERCP in Patients of Advanced Age with Acute Cholecystitis

作　　者：解民鹏 麻树人[2] 张宁[2] 张迎春[2] 王静[2] 

机构地区：[1]江苏省宿迁市第一人民医院消化内科,江苏宿迁223800 [2]沈阳军区总医院内窥镜科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2015年第1期17-20,共4页Trauma and Critical Care Medicine

摘　　要：目的探讨内镜下逆行胰胆管造影术(ERCP)在高龄急性胆囊炎患者中的临床应用价值。方法选取2011年10月至2013年10月沈阳军区总医院收治的符合诊断标准的高龄急性胆囊炎患者95例,其中经ERCP行内镜下胆囊置管引流术(ENGBD)治疗的55例为实验组,经皮经肝胆囊穿刺引流术(PTGBD)治疗的40例为对照组。观察记录两组后患者的白细胞及总胆红素的变化。研究对比两组患者在平均手术时间、住院时间、手术疗效及术后并发症等方面的差异。结果 (1)两种治疗方法在平均手术时间、平均住院时间及术后缓解率等方面比较,差异无统计学意义;(2)术后评价手术疗效,ENGBD组总有效率为100%,PTGBD组为95%,两组总有效率比较,差异无统计学意义;(3)两组患者的白细胞及总胆红素值术后24 h比较,差异有统计学意义(P<0.05);(4)经PTGBD治疗后的患者并发症多,与ENGBD组相比,差异有统计学意义(P<0.05)。结论 ENGBD及PTGBD是治疗高龄急性胆囊炎患者的有效方法,ENGBD更显著地降低了术中及术后各种并发症的发生率,降低了死亡率,提高了患者的生存率。Objective To evaluate the clinical effect of endoscopic retrograde cholangiopancreatography（ERCP） in elderly patients with acute cholecystitis.Methods Totally 95 cases of elderly patients with acute cholecystitis from Shenyang military region general hospital were obtained in this study between October 2011 to October 2013.Among them,55 cases that cured by ENGBD were set as the experimental group and 40 cases that cured by PTGBD were set as controll group.We observed and recorded the variation of leukocyte and total bilirubin between the two groups,then studied and compared the average time of operation,average time of hospital stays,curative effect and postoperative complications to find out the difference.Results（1） There was no statistically significant difference between the two methods of treatment in average operation time,average length of hospital stay and postoperative long-term remission rate and so on.（2） Evaluating the effect of surgery we could find that the total effective rate of ENGBD was 100% while the PTGBD was 95%.There was no significant difference between the two groups（P〉0.05）.（3） White blood cells and total bilirubin between the two groups had difference after 24 hours postoperntively（P〈0.05）.（4） The postoperative complications between the two groups had significant difference（P〈0.05）.The PTGBD group is more prone to suffer postoperative complications when compared with the ENGBD group（P〈 0.05）.Conclusion ENGBD and PTGBD are effective methods for the treatment of elderly patients with acute cholecystitis,ENGBD reduces the incidence of intraoperative and postoperative complications significantly,and reduce the mortality and improve the survival rate of patients.

关 键 词：急性胆囊炎 高龄 内镜逆行胰胆管造影术 内镜下胆囊置管引流术 经皮经肝胆囊穿刺引流 

分 类 号：R575.61[医药卫生—消化系统]