急诊十二指肠镜诊治老年急性胆管炎并胆总管结石的临床疗效评价  

Emergency duodenoscopy for diagnosis and treatment of acute cholangitis with choledocholithiasis in elderly patients

作　　者：张超[1] 蔡旺 董晓萌[3] 秦鸣放 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市中西医结合医院(南开医院)微创外科,天津市300100 [3]天津中医药大学研究生院,天津市300073

出　　处：《世界华人消化杂志》2015年第34期5533-5538,共6页World Chinese Journal of Digestology

基　　金：天津市卫生局科技基金资助项目;No.2013KZ054~~

摘　　要：目的:探讨入院12 h内急诊十二指肠镜诊治老年急性胆管炎并胆总管结石的疗效及临床意义.方法:回顾性分析2013-05/2014-08天津市中西医结合医院(南开医院)内镜中心80岁以上老年急性胆管炎并胆总管结石患者291例,其中入院早期药物保守治疗组(保守组)210例,入院12 h内急诊十二指肠镜治疗组(内镜组)81例.比较治疗前与治疗后1、4 d白细胞(white blood cell,WBC)、血清总胆红素(serum total bilirubin,STB)、结合胆红素(conjugated bilirubin,CB)、碱性磷酸酶(alkaline phosphatase,ALP)、?-谷氨酰转移酶(?-glutamyl transferase,GGT)、C反应蛋白(C-reactive protein,CRP)水平变化程度,体温恢复正常、腹部压痛明显消失所需时间及住院总天数等指标.结果:两组相比较,在入院早期治疗后1 d内镜组STB、CB、ALP、GGT水平比保守组下降程度更明显(66.81?mol/L±36.96?mol/L vs 18.36?mol/L±31.39?mol/L,49.06?mol/L±23.24?m o l/L vs 14.41?m o l/L±19.69?mol/L,40.57 U/L±29.43 U/L vs 16.21 U/L±34.47 U/L,36.44 U/L±27.01 U/L vs 14.97U/L±29.70 U/L;均P<0.05),在入院早期治疗后4 d内镜组WBC、STB、CB、ALP、G G T、C R P水平比保守组均显著降低(5.77×109/L±1.74×109/L vs 3.58×109/L±1.33×109/L,90.78?m o l/L±55.93?m o l/L v s55.75?mol/L±86.94?mol/L,60.61?mol/L±31.27?mol/L vs 53.07?mol/L±63.55?mol/L,88.91 U/L±40.26 U/L vs 21.59 U/L±39.76 U/L,96.53 U/L±76.62 U/L vs 33.34U/L±59.47 U/L,10.67 mg/L±17.19 mg/L vs5.43 mg/L±10.21 mg/L;均P<0.05).内镜组的体温恢复正常、腹部压痛明显消失所需时间及住院总天数比保守组更短(3.65 d±1.21 d vs 4.14 d±1.58 d,1.67 d±0.86 d vs2.40 d±1.17 d,11.41 d±4.90 d vs 14.65 d±6.68 d;均P<0.05).结论:入院12 h内急诊十二指肠镜逆行性胰胆管造影(endoscopic retrograde cholan giopancreatography,ERCP)并放置鼻胆管(endoscopic nasobiliary drainage,ENBD)进行早期治疗,与入院早期单纯药物治疗后再一次性内镜取石相比较,前者症状缓解更显著,疗效更AIM：To assess the efficacy of emergency duodenoscopy in the diagnosis and treatment of acute cholangitis with common bile duct stones in elderly patients.METHODS：A retrospective analysis was performed of 291 patients aged over 80 years with acute cholangitis and common bile duct stones from May 2013 to August 2014,including 210 cases who underwent early conservative treatment（conservative group）and 81 cases who underwent emergency duodenoscopic treatment within 12 h of hospitalization（endoscopic group）.White blood cell（WBC）,serum total bilirubin（STB）,conjugated bilirubin（CB）,alkaline phosphatase（ALP）,γ-glutamyl transferase（GGT）,and C-reactive protein（CRP） before treatment and1,4 d after treatment,the time required for body temperature to return to normal,the time to disappearance of abdominal tenderness and the total number of days of hospitalization were compared between the two groups.RESULTS：Compared with the conservative group,STB,CB,ALP and GGT levels on 1 d after treatment decreased more significantly in the endoscopic group（66.81 μmol/L ± 36.96μmol/L vs 18.36 μmol/L ± 31.39 μmol/L,49.06μmol/L ± 23.24 μmol/L vs 14.41 μmol/L ± 19.69μmol/L,40.57 U/L ± 29.43 U/L vs 16.21 U/L± 34.47 U/L,36.44 U/L ± 27.01 U/L vs 14.97U/L ± 29.70 U/L;P〈0.05 for all）.On 4 d,WBC,STB,CB,ALP,GGT and CRP levels decreased more significantly in the endoscopic group than in the conservative group（5.77 × 10~9/L ± 1.74× 10~9/L vs 3.58 × 10~9/L ± 1.33 × 10~9/L,90.78μmol/L ± 55.93 μmol/L vs 55.75 μmol/L ± 86.94μmol/L,60.61 μmol/L ± 31.27 μmol/L vs 53.07μmol/L ± 63.55 μmol/L,88.91 U/L ± 40.26 U/L vs 21.59 U/L ± 39.76 U/L,96.53 U/L ± 76.62U/L vs 33.34 U/L ± 59.47 U/L,10.67 mg/L ±17.19 mg/L vs 5.43 mg/L ± 10.21 mg/L;P〈0.05 for all）.The time required for body temperature to return to normal,time to disappearance of abdominal tenderness and the total number of days of hospitalization in the endoscopic group were significantly shorter than those in the conse

关 键 词：急诊 十二指肠镜 老年患者 急性胆管炎 胆总管结石 

分 类 号：R657.41[医药卫生—外科学]