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目的:探讨高龄患者急性化脓性胆管炎的特点和急诊内镜治疗方法。方法:65例80岁以上高龄患者因急性化脓性胆管炎接受内镜逆行胆胰造影(ERCP)检查和治疗,60例治疗成功,治疗方法包括乳头括约肌切开(EST)取石术、放置鼻胆管引流(ENBD)、内支架引流(ERBD)。结果:18例经EST取石,其中8例术后放置ENBD,3例放置ERBD;34例单纯放置ENBD,8例放置ERBD。53例患者经急诊治疗后症状得到缓解,7例未见好转,其中4例随后行开腹手术治疗,最终5例病死。结论:内镜治疗急性化脓性胆管炎较传统开腹手术具有操作简单、安全、有效、创伤小和恢复快等优点,尤其对于高龄患者更显其微创优点。
Objective: To investigate the characteristics of acute suppurative cholangitis in elderly patients and emergency endoscopic treatment. Methods: Sixty-five elderly patients over 80 years of age underwent endoscopic retrograde cholangiopancreatography (ERCP) examination and treatment of 60 cases of acute suppurative cholangitis. The treatment included sphincterotomy (EST) and nasobiliary duct placement Drainage (ENBD), Stent drainage (ERBD). RESULTS: Eighteen patients were treated by EST. Among them, 8 cases had ENBD after operation and 3 cases had ERBD. Only 34 patients had ENBD and 8 patients had ERBD. After the emergency treatment, 53 patients were relieved of symptoms, 7 patients did not improve, 4 of them were treated by laparotomy and finally 5 patients died. Conclusion: Endoscopic treatment of acute suppurative cholangitis has the advantages of simple operation, safe and effective, less trauma and faster recovery than traditional laparotomy, especially for elderly patients.