经鼻胆管冲洗胆道+灌注高浓度抗生素治疗急性梗阻性化脓性胆管炎

目的：探讨B超监视下经内镜鼻胆管引流术(ENBD),用生理盐水冲洗胆道+局部灌注高浓度抗生素,治疗急性梗阻性化脓性胆管炎的疗效及安全性。方法：对22例急性梗阻性化脓性胆管炎的患者,采取B超监视下行ENBD术、术后经鼻胆管行胆道冲洗及灌注高浓度抗生素为主的非手术综合治疗,对比患者治疗前后的血清总胆红素水平、肝功能、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22例患者除1例因壶腹癌行保守治疗外,其余21例内镜下鼻胆管引流术成功,胆汁引流通畅,经胆道冲洗+灌注高浓度抗生素治疗后治愈。结论：急性梗阻性化脓性胆管炎在B超监视下行ENBD术较X监视行ENBD术,胰腺炎并发症发生率降低。经鼻胆管用生理盐水冲洗胆道+局部灌注高浓度抗生素为主的综合治疗是有效的、安全的。

The treatment of acute obstructive suppurative cholangitis with saline clusis of biliary tract plus high-concentration antibioltic instillation

Objective:To evaluate feasibility and therapeutic effect of endoscopic nasobiliary drainage(ENBD) under B supersonic guidance,with the aid of saline flush followed by high-concentration antibiotic instillation of the biliary tract for the treatment of acute obstructive suppurative cholangitis(AOSC).Methods:Twenty-two pa- tients with AOSC underwent non-surgical comprehensive therapy,including saline flush of biliary tract and local high-concentration antibiotic instillation,through the endoscopically introduced naso-biliary catheter.The changes in the levels of serum total bilirubin,liver function parpmeters,and common bile duct diameter were determined both preoperatively and postoperatively,the clinical data of the patients were analysed.Results:The introduction of the naso-biliary catheters through the endoscope and bile drainage were successful in 21 out of 22 patients,ex- cept in one patient percutaneous transhepatic biliary drainage(PTBD)was performed after the failure of ENBD. They were all treated with flusing of the biliary tract with saline plus instillation of high-concentration antibiotic into the bile duct.Conclusion:ENBD under B supersonic guidance and saline flusing of biliary tract plus instilla- tion of high-concentration antibiotic is an effective and safe treatment in acute obstructive suppurative cholangitis.