内镜下鼻胆管引流治疗急性梗阻性化脓性胆管炎（附25例报告）

目的 探讨急性梗阻性化脓性胆管炎伴多器官衰竭的治疗方法。方法 对25例急性梗阻性化脓性胆管炎伴多器官衰竭的患者采取以内镜下鼻胆管引流术、经鼻胆管冲洗及灌注抗生素为主的非手术综合治疗，观察患者治疗前后的血清总胆红素水平、B超下胆总管内径变化，并对患者临床资料进行回顾性分析。结果 本组25例患者除2例需转外科急诊手术治疗外，其余23例内镜下胰胆管造影、内镜下鼻胆管引流术成功，胆汁引流通畅，多器官衰竭得以纠正，急性梗阻性化脓性胆管炎伴多器官衰竭治愈率为92．0％。结论 对急性梗阻性化脓性胆管炎伴多器官衰竭患者采取内镜下鼻胆管引流术、静脉应用和经鼻胆管冲洗及灌注抗生索为主的综合治疗是有效、安全的。

Endoscopic nasobiliary drainage for acute obstructive suppurative cholangitis with multiple organ failure: report of 25 cases]

OBJECTIVE: To explore the treatment of acute obstructive suppurative cholangitis (AOSC) with multiple organ failure (MOF). METHODS: Twenty-five patients with AOSC complicated by MOF underwent non-surgical comprehensive therapies, including endoscopic naso biliary drainage (ENBD), flushing and antibiotic perfusion through the naso biliary catheter. The alterations of the levels of serum total bilirubin and common bile duct diameter were measured both preoperatively and postoperatively, with retrospective analysis of the patients' clinical record. RESULTS: Of all the 25 patients, 23 underwent endoscopic retrograde cholangiopancreatography (ERCP) with successful placement of the nasobiliary catheters and bile drainage, and MOF was corrected. The cure rate of the this group of patients was 92.0%, with two cases being transferred for emergency surgical treatment. CONCLUSION: Comprehensive treatment consisting of ENBD, flushing and antibiotic perfusion through the naso biliary catheter and intravenous use of antibiotics is effective and safe for the treatment of AOSC complicated by MOF.