不同术式治疗性ERCP在抢救急性梗阻性化脓性胆管炎中的作用研究

目的胆管结石引起急性梗阻性化脓性胆管炎首要治疗是要进行胆道紧急减压。本研究的目的就是研究不同术式治疗性ERCP（VTTFERCP）在抢救急性化脓性胆管炎（AOSC）中的价值。方法经临床确诊由于胆管结石引起的15例AOSC患者，接受VTTERCP，观察手术治疗效果和并发症。结果（1）接受ERCP＋EST＋胆道冲洗＋ENBD的手术2例；（2）ERCP＋EST＋取石＋胆道冲洗3例；（3）ERCP＋EST＋取石＋胆道冲洗＋ENBD2例；（4）ERCP＋EST＋部分取石＋胆道冲洗＋EBND2例；（5）ERCP＋EST4-碎石＋取石＋胆道冲洗2例；（6）ERCP＋EST＋碎石＋取石＋胆道冲洗＋EBND2例；（7）ERCP＋EST＋部分取石＋支架置入＋经支架胆道冲洗2例。本组VTrERCP手术成功率100％，治愈率100％，安全率100％。第（4）组1例术后化脓性胆管炎治愈后转当地医院手术取石，无1例并发症或死亡者。结论VTTFERCP手术方式是抢救AOSC一种非常好的方法，效果可靠，安全。

Evaluation of the Efficacy and Safety of Varied Type Therapeatic Endocopic Retrograde Cholangiopancreatography in Rescuring Acute Obstructive Suppurative Cholangitis

Objective Acute obstructive suppurative cholangitis（AOSC） due to choledocholithiasis in an emergency siuation that requires urgent biliary decompression. The aim of the study is to present our policy for the treatment of AOSC due to choledocholithiasis by the varied type therapeutic endoscopic retrogreade cholangio pancreatography （VTrERCP） Methods 15 patients presenting AOSC due to choledocholithiasis underwent VTTERCP to detecting the effect and complication. Results （1） 2 patients had AOSC underwent ERCP, endoscopic sphincterotomy （EST）, biliary tract rinsing and endoscopic nosal biliary drainage（ENBD）; （2）3 patients underwent ERCP, EST, expulsion of the stone and biliary tract rinsing; （3） 2 patients underwent ERCP, EST, expalsion of the stone, biliary tract rinsing and ENBD. （4） 2 patients acce pted ERCP, EST partly expulsion of stone, biliary tract rinsing and ENBD; （5） 2 patients underwent ERCP, EST, lithotripsy, expulsion of the stone and＂ biliary tract rinsing; （6）2 patients underwent ERCP, EST, lithotripsy expulsion of the stone, hiliary tract rinsing and ENBD ; （7） 2 patients underwent ERCP, EST, partly expulsion of the stone, stent insertion and biliary tract rinsing by stent. The succeed rate of procedure was 100% ,the rate of curation was 100% ,the rate of safety was 100%, one patient transferred to loeal hospital for surgical operation for expulsion of the stone after AOSC completely care in group. There was on complication, no death in all of the group. Conclusion VTrERCP is a proper method for rescuing AOSC. It was effective and safe.