高龄患者急性化脓性胆管炎的急诊内镜治疗

目的:探讨高龄患者急性化脓性胆管炎的特点和急诊内镜治疗方法.方法:65例80岁以上高龄患者因急性化脓性胆管炎接受内镜逆行胆胰造影(ERCP)检查和治疗,60例治疗成功,治疗方法包括乳头括约肌切开(EST)取石术、放置鼻胆管引流(ENBD)、内支架引流(ERBD).结果:18例经EST取石,其中8例术后放置ENBD,3例放置ERBD;34例单纯放置ENBD,8例放置ERBD.53例患者经急诊治疗后症状得到缓解,7例未见好转,其中4例随后行开腹手术治疗,最终5例病死.结论:内镜治疗急性化脓性胆管炎较传统开腹手术具有操作简单、安全、有效、创伤小和恢复快等优点,尤其对于高龄患者更显其微创优点.

Emergent Therapeutic ERCP in Elderly Patients with Acute Suppurative Cholangitis

Objective：To study the efficacy of emergent endoscopic management for acute suppurative cholangitis in the elderly patients.Methods：A total of 65 elderly patients with acute suppurative cholangitis underwent diagnostic endoscopic retrograde cholangiopancreatogrophy（ERCP）,and emergent therapeutic ERCP succeeded in 60 patients（92.3%）.The therapeutic ERCP included stones removal after endoscopic sphincterotomy（EST）,stones removal and subsequent endoscopic nasobiliary drainage （ENBD） or endoscopic retrograde biliary drainage（ERBD）.Results：Stones removal or subsequent ENBD or ERBD were performed in 18 patients.Forty-two patients received emergent ENBD or ERBD only.Symptoms of 53 patients were relieved after the management described above,while 7 patients weren＇t relieved.Four of them accepted laparotomy.Finally 5 patients were died.Conclusions：Compared with surgery,emergent therapeutic ERCP is a safe,simple and effective measure for acute cholangitis,it offers an important alternative in the treatment of acute cholangitis,especially in elderly patients.