个体化治疗老年急性梗阻性化脓性胆管炎患者的临床研究

doi:10.3969/j.issn.1006-7795.2015.03.022

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (3): 449-453.doi: 10.3969/j.issn.1006-7795.2015.03.022

个体化治疗老年急性梗阻性化脓性胆管炎患者的临床研究

宋勇¹, 黄亚川², 秦高平²

1. 陕西省人民医院肝胆外科, 西安 710068;
2. 陕西省人民医院整形外科, 西安 710068

收稿日期:2015-02-08 出版日期:2015-06-21 发布日期:2015-06-15
通讯作者: 宋勇 E-mail:songyongbetter@163.com
基金资助:
中国博士后第55批自然科学基金资助 (2014M552459), 西安市科技厅自然科学基金资助 (2012D37).

Clinical studies on individual therapy for acute suppurative cholangitis in aged patients

Song Yong¹, Huang Yachuan², Qin Gaoping²

1. Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, China;
2. Department of Aesthetic Plastic Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, China

Received:2015-02-08 Online:2015-06-21 Published:2015-06-15
Supported by:
This study was supported by the China Postdoctoral Science Foundation(2014M552459), Natural Science Foundation of Xi'an City Science and Technology Department (2012D37).

摘要/Abstract

摘要：

目的比较经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+ 十二指肠乳头括约肌切开术(endoscopic nasobiliary drainage, ENBD)+ 经内镜鼻胆管引流术(endoscopic sphincterotomy,EST)和经皮经肝胆管引流术(percutaneous transhepatic cholangial drainage, PTCD)对急性梗阻性化脓性胆管炎(acute obstructive suppurative cholangitis, AOSC)患者的治疗效果,为临床治疗AOSC手术方式的选择提供依据.方法回顾性分析2009年12月至2014年1月间,共93例老年急性梗阻性化脓性胆管炎患者临床资料,其中ERCP+EST+ENBD (A组)42例,PTCD(B组)51例,对比2种方法临床治疗效果.结果 93例患者均成功施行介入术及内镜治疗,PTCD耐受性更好,引流效果更确切,ERCP+EST+ENBD在控制性损伤最小化的前提下提供了解决胆管结石梗阻的方案.结论 PTCD用于治疗AOSC,成功率较高,引流效果可靠,能充分降低胆道压力,降低风险,为二期手术治疗创造了机会和条件,ERCP+EST+ENBD在微创的前提下提供了解决结石梗阻的机会.

关键词: 急性梗阻性化脓性胆管炎, 经皮肝穿刺引流, 损伤控制性外科

Abstract:

Objective To compare endoscopic retrograde cholangio-pancreatography (ERCP) + endoscopic sphincterotomy (EST) + endoscopic nasobiliary drainage (ENBD) and percutaneous transhepatic cholangial drainage (PTCD) operation for acute obstructive suppurative cholangitis (AOSC) in aged patients with the treatment effect, and provide the basis for the treatment of AOSC operation mode selection. Methods Retrospective analysis of 93 patients with acute obstructive suppurative cholangitis in patients with clinical data of our hospital from December 2009 to January 2014, including ERCP+EST+ENBD (A group) 42 cases, PTCD 51 cases (B group), compared with the 2 methods of treatment effect.Results Totally 93 cases had successful intervention and endoscopic therapy, PTCD tolerance better drainage effect more precisely, ERCP+EST+ENBD provides a solution of calculus of bile duct obstruction cases in control of damage is minimized under the premise. Conclusion PTCD for the treatment of AOSC, the success rate is high, the drainage effect is reliable, can fully reduce the pressure of biliary tract, reduce clinical risk, creating opportunities and conditions for the two stage surgical treatment, but the ERCP+EST+ENBD in minimally invasive premise provides a solution for biliary calculi obstruction.

Key words: acute obstructive suppurative cholangitis (AOSC), percutaneous transhepatic biliary drainage (PTCD), damage control surgery(DCS)

中图分类号:

R575.7

宋勇, 黄亚川, 秦高平. 个体化治疗老年急性梗阻性化脓性胆管炎患者的临床研究[J]. 首都医科大学学报, 2015, 36(3): 449-453.

Song Yong, Huang Yachuan, Qin Gaoping. Clinical studies on individual therapy for acute suppurative cholangitis in aged patients[J]. Journal of Capital Medical University, 2015, 36(3): 449-453.

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个体化治疗老年急性梗阻性化脓性胆管炎患者的临床研究

Clinical studies on individual therapy for acute suppurative cholangitis in aged patients

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