床旁无X线下胆道支架引流术治疗高龄急性梗阻性化脓性胆管炎患者的临床疗效初探  

A preliminary study on the clinical efficacy of bedside x-ray-free biliary stent drainage in the treatment of elderly patients with acute obstructive septic cholangitis

作　　者：文冠璋 张志强[1] WEN Guan-zhang;ZHANG Zhi-qiang(The Second Department of Gastroenterology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院消化病中心消化二科,830000

出　　处：《现代消化及介入诊疗》2024年第4期407-410,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：新疆维吾尔自治区自然科学基金-科技创新团队(天山创新团队)2022TSYCTD80018。

摘　　要：目的研究床旁无X线胆道支架引流术(ERBD)在治疗高龄急性梗阻性化脓性胆管炎(AOSC)患者的临床疗效。方法回顾分析新疆医科大学第一附属医院消化病中心2019年1月至2023年1月行紧急内镜下ERBD治疗18例高龄(≥80岁)AOSC患者的临床资料,根据患者病情危重程度和能否脱离重症监护分为床旁无X线辅助引流组(A组)和在介入室行X线下辅助引流组(B组)。通过对比分析两组患者术前、术后白细胞计数、炎症因子、转氨酶、胆红素等指标和术后并发症发生情况综合评价手术安全性和有效性。结果在经紧急床旁无X线下ERCP治疗的10例AOSC患者均插管成功,插管成功率为100%。在X线引导下行紧急ERCP治疗的8例AOSC患者也均插管成功。患者术后检测相关感染指标均明显下降至恢复正常。A组(床旁无X线辅助引流)出现轻症胰腺炎1例,并发症发生率为10%(1/10);B组(X线辅助引流)出现轻症胰腺炎1例,发生率为12.50%(1/8)。结论对于AOSC危重症患者行床旁无X线ERBD术可快速并有效缓解患者病情。手术操作以迅速解除胆道梗阻,通畅引流胆道为主要目的,并尽可能缩短手术时间,减少并发症的发生。Objective To study the clinical efficacy of bedside X-ray-free biliary stent drainage(ERBD)in the treatment of elderly patients with acute obstructive septic cholangitis(AOSC).Methods The clinical data of 18 elderly(≥80 years old)AOSC patients who underwent emergency endoscopic ENBD at the Center for Digestive Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2023 were retrospectively analyzed and divided into the bedside no-X-ray-assisted drainage group(Group A)and the group that underwent subx-ray-assisted drainage in the interventional room(Group B),according to the degree of criticality of the patients'condition and the ability to be discharged from intensive care.The safety and efficacy of the procedure was evaluated by comparing and analyzing the preoperative and postoperative white blood cell counts,inflammatory factors,transaminase,bilirubin and other indexes and the occurrence of postoperative complications in the two groups.Results All 10 AOSC patients treated with emergency bedside X-ray-free ERCP were successfully intubated,and the intubation success rate was 100%.Eight AOSC patients treated with emergency ERCP under X-ray guidance were also successfully intubated.The postoperative infectious indexes of the patients were significantly reduced to normal.1 case of mild pancreatitis occurred in group A(bedside without X-ray-assisted drainage),with a complication rate of 10%(1/10);1 case of mild pancreatitis occurred in group B(X-ray-assisted drainage),with an incidence rate of 12.50%(1/8).Conclusion Bedside X-ray-free ERBD for critically ill patients with AOSC can provide rapid and effective relief.The main purpose of the operation is to rapidly relieve biliary obstruction and smooth drainage of the bile ducts,and to shorten the operation time as much as possible to minimize the occurrence of complications.

关 键 词：急性梗阻性化脓性胆管炎 无X线下胆道支架引流术 高龄 

分 类 号：R57[医药卫生—消化系统] R575.7[医药卫生—内科学]