急性重症胆管炎伴血小板减少的急诊内镜治疗  

Emergency endoscopic treatment for severe acute cholangitis complicated with thrombocytopenia

作　　者：王鼎鑫[1] 董胜肖 宋海林 邢国璋[1] 

机构地区：[1]河北省人民医院内镜室,河北石家庄050051 [2]河北省以岭医院消化科,河北石家庄050000 [3]河北省南宫冀南长城医院消化科,河北南宫051800

出　　处：《中国内镜杂志》2015年第10期1095-1098,共4页China Journal of Endoscopy

摘　　要：目的探讨急性重症胆管炎（ACST）伴血小板减少症的临床特点及急诊内镜治疗效果。方法回顾分析2011年2月-2014年1月3所医院联合收治的123例ACST患者。其中,30例ACST合并血小板减少并对其施行急诊内镜下鼻-胆管引流术（ENBD）,内镜下胆管塑料支架引流术（ERBD）及抗菌素等治疗。结果30例ACST患者中28例治愈,其治愈率92.3%（28/30）,死亡2例,病死率6.7%（2/30）,2例死亡者均因就诊时间〉24 h,病情危重,均死于多脏器衰竭（MOF）。28例治愈者均经内镜下胆管引流及抗感染治疗,5~12 d内血小板计数（PLT）随感染控制渐渐恢复正常范围。结论于ACST合并血小板计数减少的患者中,血小板数量的下降对ACST病情的判断、治疗及预后具有很重要的价值,内镜下ENBD及ERBD微创治疗对ACST伴血小板减少的患者,具有创伤小,并发症少,死亡率低的优势,是ACST伴血小板减少症首选方法。【Objective】 To explore the effect of emergency endoscopic treatment for severe acute cholangitis complicated with thrombocytopenia. 【Methods】 Retrospective analysis of 128 cases from 2011 January to 2014 January treated in three hospital, including 30 cases of severe acute cholangitis complicated with thrombocytopenia and the implementation of the emergency endoscopic naso biliary drainage（ENBD）, drainage endoscopic biliary plastic stent（ERBD） treatment.【Results】Among the 30 severe acute cholangitis patients, 28 cases were cured, the cure rate was 92.3 %（28/30）, 2 cases died, the mortality rate of 6.7 %（2/30）, the death causes of 2 cases are due to visit time 24 h, critical illness, died of multiple organ failure（MOF）. 28 cases were cured by both endoscopic biliary drainage and anti infection treatment, 5 ~12 days, the platelet count returned to normal range with infection control.【Conclusions】In severe acute cholangitis patients with reduced platelet counts, the number of platelets has very important value for treatment, prognosis judgment. Endoscopic minimally invasive treatment of ENBD and ERBD on severe acute cholangitis patients with thrombocytopenia show less trauma, less complications, and low death rate.

关 键 词：急性重症胆管炎 血小板减少 急诊内镜 鼻胆管引流 胆管塑料支架引流 

分 类 号：R575.7[医药卫生—消化系统]