免X线胆道内引流治疗老年急性重症胆管炎  

Treatment of acute cholangitis of severetype of endoscopic internal biliary drainage in non X-ray

作　　者：陶杰[1] 陈晶[1] 杨雪[1] 孙昊[1] 王林[1] 刘青光[1] 

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华腔镜外科杂志（电子版）》2015年第3期26-29,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨急诊床旁免X线内镜下胆道内引流治疗急性重症胆管炎(ACST)的疗效。方法对危重不宜搬运的老年ACST患者行急诊床旁免X线内镜下胆道内引流治疗,观察术后患者症状的改善情况及疗效。结果 30例患者中,29例手术成功,1例因憩室内乳头,反复插管失败,未完成操作。27例症状明显缓解,有效率为93%;术后腹痛、发热均在短时间内得到控制,黄疸减退,生命体征平稳。各项生化指标明显下降,术前、术后比较,差异有统计学意义(P<0.05)。1例患者因胆道出血而感染控制不佳,行开腹手术;1例因支架早期脱落症状再发,床旁X线证实后,二次留置支架后症状缓解。未发现与内镜操作相关的严重并发症,如消化道穿孔、出血、急性重症胰腺炎、死亡等。结论急诊床旁免X线内镜下胆道内引流是治疗ACST的有效方法,适用于患者病情极危重、不宜搬运或难以耐受急诊外科手术的老年高龄患者,不适合扩大适应证范围,且要求经验丰富的内镜医师操作。Objective To study the results of emergency bedside experience of treatment of acute cholangitis severetype of endoscopic internal biliary drainage in non X-ray. Methods To observe the patient＇s symptoms improved and curative effect of postoperative patients who emergency bedside experience of endoscopic internal biliary drainage in non X-ray. Results 29 cases of 30 patients were successful operation,The other 1 case with papillary diverticulum,repeated intubation failure,the operation did not complete. 27 cases of patients with symptoms,effective rate was 93%; postoperative abdominal pain,fever were controlled within a short period of time,jaundice,stable vital signs. The biochemical indexes were decreased,there was significant difference（ P 0. 05）. One patient with biliary tract hemorrhage and poor infection control,laparotomy operation; One case of patients with biliary stent loss in the early postoperative period,indwelling again after bedside X-ray confirmed. No severe complications related to the endoscopic operation occurred. Conclusions Emergency bedside X-ray free endoscopic internal biliary drainage is an effective method for the treatment of acute cholangitis severetype,suitable for patients with severe,not suitable for move or difficult to tolerate emergency surgery operation in elderly patients with,not suitable for expanding the scope of indications,and need experienced endoscopists.

关 键 词：内镜 塑料内支架 急性重症胆管炎 免X线 

分 类 号：R657.41[医药卫生—外科学]