急诊内镜介入治疗老年急性梗阻性化脓性胆管炎的临床疗效观察

摘要

目的：观察急诊内镜介入治疗老年急性梗阻性化脓性胆管炎（ AOSC ）的临床价值与疗效。方法：将普外科收治的72例老年AOSC患者按照不同治疗方法随机分为内镜组（ n＝36）和开腹组（ n＝36）。内镜组予内镜下十二指肠乳头括约肌切开术（ EST）和鼻胆管引流术（ ENBD）或胆管下内支撑引流术（ ERBD）治疗，开腹组予胆囊切除及胆道探查术治疗。观察比较两组患者临床疗效、并发症发生率、血常规、肝功能等生化指标水平及手术相关指标。结果：内镜组总治愈率显著优于开腹组（100％vs 66．7％），并发症发生率显著低于开腹组（2．8％vs 22．2％）（P＜0．05）；内镜组患者术中出血量、肛门排气时间及住院时间均显著低于对照组（ P＜0．05）；术后一周，内镜组患者血白细胞、直接胆红素、谷丙转氨酶水平较对照组均显著降低，血清白蛋白、胆碱酯酶水平较对照组均显著升高（ P＜0．05），差异有统计学意义。结论：急诊内镜介入治疗老年AOSC具有安全性高、创伤小、并发症少、住院时间短等优点，具有手术治疗无法替代的优势，值得临床推广应用。%Objective:To observe the clinical effect of emergency endoscopic interventional therapy for elderly patients with acute obstructive suppurative cholangitis.Method:72 cases of senile AOSC patients in our hospital, according to different methods of treatment were divided into endoscopic surgery group ( n=36) and open surgery group ( n=36) .Endoscopic incision group treated with EST and ENBD or ERBD treat-ment, the open group treated by cholecystectomy and common bile duct exploration.Compared the two groups of blood routine test, liver function and other biochemical indexes level and operation related index.Result:The total cure rate of endoscopic group was significantly better than the open surgery group( 100%vs 66.7%) ( P <0.05); complications of endoscopic group were significantly lower than the open arugery group (2.8%vs 22.2%) ( P <0.05); endoscopic group patients bleeding, anal exhaust time and hospital stay were significantly lower than those of the control group ( P <0.05); one week after operation, white blood cell of patients, direct bilirubin, alanine aminotransferase levels of endoscopic group were significantly lower than those in control group, serum albumin, cholinesterase levels were significantly increased as com-pared with the control group ( P <0.05) , the difference was statistically significant.Conclusion:Emergency endoscopic interventional therapy for elderly patients with AOSC has the advantages of high safety, less trau-ma, less complications, short hospitalization time, it has irreplaceable advantage of open operation treat-ment, it is worthy of clinical application.