重症胆管炎急诊内镜治疗的临床分析

目的：分析急诊内镜下治疗重症胆管炎的成功率与并发症，观察胆道菌群分布状态、药物敏感谱的变异，探讨急诊治疗重症胆管炎的方法及用药方法。方法：急诊就诊的重症胆管炎患者186例，就诊24h内行ERCP检查并同时进行内镜下治疗，部分患者术中深插管收集胆汁并抽取外周血进行细菌培养及药敏实验。结果：186例重症胆管炎中，胆总管结石占72．6％（135／186），156例患者胆汁细菌检出率为62．8％；10种药物敏感率有显著性差异。经内镜下治疗的总成功率达94．1％。结论：经内镜下治疗重症胆管炎简便、快速、安全，而且成功率高、并发症少，应作为急诊首选治疗方法。胆道疾病患者胆汁细菌检出率高，血培养阳性率低，应重视胆汁细菌培养及药敏试验，以指导临床用药。

Emergency endoscopic treatment for the patients with severe acute cholangitis-analysis of 186 cases

Objective To evaluate the outcome of therapeutic ERCP for the patients with severe acute cholangitis and to observe bacteria distribution and it's drugs sensitivity. This study would give suitable instruction to clinical drug use.Methods 186 cases with severe acute cholangitis in an emergency were treated with therapeutic ERCP.Meanwhile bile of 156 cases was collected and cultured respectively during ERCP operation.Ten kinds of drug papers were used for investigating their sensitivity.The data were analysed by statistical method.Results The abnormal findings were common bile duct(CBD) stones (72.6%) in 186 cases with severe acute cholangitis in an emergency.Bacterial positive rate of 156 bile samples was 62.8%.The drug resistance rate of bacteria against 10 kinds of drugs was significantly different( P <0 001).The success rate of therapeutic ERCP of those patients with severe acute cholangitis in an emergency was 94.1%.Conclusions The therapeutic ERCP should be the first choice for those patients with severe acute cholangitis in an emergency.The value of bile bacteria culture should be emphasized when the positive rate of blood culture was lower.