超声引导在急性化脓性胆管炎内镜治疗中的应用研究

目的探讨超声引导在急性化脓性胆管炎内镜治疗中的应用价值。方法对65例急性化脓性胆管炎的患者行急诊超声引导下内镜治疗,包括鼻胆管放置引流术（ENBD）,乳头括约肌切开及取（碎）石术（EST）,掏取肝吸虫和胆管狭窄扩张术。术后所有患者行X-线下内镜逆行性胆胰管造影（ERCP）确认治疗效果。结果（1）本组所有病例均在超声引导下经内镜放置鼻胆管,其中10例因病情严重,仅安置鼻胆管,未做进一步内镜治疗,与X线ERCP对照,符合率为100%;（2）有45例经超声引导行EST术（内镜下乳头括约肌切开取石术）,与X-线ERCP对照,取石成功率97.8%（44/45）,判断胆总管结石是否完全取出及残留的超声符合率分别为92.3%（36/39）、80.0%（4/5）,超声总符合率为90.9%（40/44）。取石术后并发症发生率为9.1%（4/44）;（3）超声引导经内镜掏取肝吸虫及反复冲洗胆管7例,行胆管狭窄扩张术3例,与X-线ERCP对照,均获得满意效果。结论超声引导内镜治疗急性化脓性胆管炎简便快捷、安全有效,可以部分替代X-线引导,还具有经济,无辐射,无过敏,可进行床边急诊内镜诊治技术等特点,值得临床推广应用。

Ultrasound-guided Endoscopic Therapy for Acute Suppurant Cholangitis

Objective To investigate the clinical value of ultrasound-guided endoscopic therapy for acute suppurant cholangitis.Methods Emergency ultrasound guided endoscopic therapy was performed in 65 patients with acute suppurent cholangitis.The endoscopic procedures were included endoscopic nasal biliary drainage(ENBD),endoscopic sphincterotomy(EST),extraction of liver trematode and dilatation of bile duct stricture.Endoscopic retrograde cholangiopancreatography(ERCP)was performed for efficacy evaluation.Results(1)Trans-nasal drain-age tube was placed into the bile duct in all patients using endoscopy under ultrasound guidance.Ten patients did not receive further endoscopic therapy for severe situation.The agreement between ultrasound and ERCP was 100%.(2)Ultrasound-guided EST was performed in 45 patients.As compared with ERCP,the successful rate of stone extraction was 97.8%(44/45).In evaluating whether common bile duct(CBD)stone extraction was complete or incomplete,the agreement between ultrasound and ERCP were 92.3%(36/39)and 80.0%(4/5)respectively.The total agreement of ultrasound was 90.9%(40/44).The complication rate for lith extraction was 9.1%(4/44).(3)Ultrasound-guided extraction of liver trematode and dilatation of bile duct stricture were performed in 7 and 3 patients respectively.Conclusions Ultrasound-guided endoscopic therapy in acute suppurant cholangitis is easy to perform,safe and effective and partly may replace X-ray in guidence.Ultrasound has the virtues such as costeffec-tive,no radiation,no allergic reaction and feasibility for bedside and emergency,which is worthy for clinical wide use.