Significance of endoscopic drainage procedures selected to treat acute cholangitis of severe type in elderly patients with chronic respiratory disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

BAYongjiang ¹ , YUEPing ² , ZHANGYong ³ , BAIBing ² , LINYanyan ² , ZHAOSheng ¹ , ZHANGJingduo ¹ ,  MENGWenbo ^1,2,4,5 , LIXun ^1,4,5,6

1. First Clinical School of Lanzhou University, Lanzhou 730000, P.R.China;
2. Department of Special Minimally Invasive Surgery, First Hospital of Lanzhou University, Lanzhou 730000, P.R.China;
3. First Department of General Surgery,The Second People’s Hospital of Lanzhou City, Lanzhou 730000, P.R.China;
4. Hepatopancreatobiliary Institute of Gansu Province, Lanzhou 730000, P.R.China;
5. Biological Therapy and Regenerative Medicine Transformation Center of Gansu Province, Lanzhou 730000, P.R.China;
6. Second Deprtment of General Surgery, First Hospital of Lanzhou University, Lanzhou 730000, P.R.China;

Corresponding author：

MENGWenbo, Email: mengwb@lzu.edu.cn

Keywords：

cholangitis; chronic respiratory disease; pumonary infection; endoscopy; elderl

DOI：

10.7507/1007-9424.201605071

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Objective To investigate the alternatives of different endoscopic drainages for acute cholangitis of severe type (ACST) in elderly patients with chronic respiratory disease. Methods The clinical data of 74 cases of ACST in elderly patients with chronic respiratory disease undergoing 3 kinds of drainages, endoscopic retrograde double biliary stent drainage (D-ERBD), endoscopic retrograde single biliary stent drainage (S-ERBD), or endoscopic nasobiliary drainage (ENBD) in the First Hospital of Lanzhou University from October 2005 to October 2015 were collected to analyze prospectively. Results Compared with preoperative, the white blood cell (WBC), direct bilirubin (DBIL), temperature, and abdominal pain NRS evaluation in 48 h after operation in 3 groups all decreased, the difference was statistically significant (P＜0.05). Compared among 3 groups, there were no significant difference among the incidences of postoperative hyperamylasemia, pancreatitis and gastrointestinal hemorrhage (P＞0.05). The group of ENBD was more likely to develop pulmonary infection and achieve a secondary treatment than other 2 groups (P＜0.05). Totally 5 patients died in 3 groups, with a mortality of 6.76%, but the mortality rates were similar among the 3 groups (P＞0.05). The deaths were predominantly caused by multiple organ failure (MOF), 4 cases of which were caused by respiratory failure related to respiratory infection. Conclusion The alternative of endoscopic retrograde double biliary stent drainage (D-ERBD) can not only alleviate cholangitis rapidly, but it can reduce the incidence of aspiration pneumonia.

Citation： BAYongjiang, YUEPing, ZHANGYong, BAIBing, LINYanyan, ZHAOSheng, ZHANGJingduo, MENGWenbo, LIXun. Significance of endoscopic drainage procedures selected to treat acute cholangitis of severe type in elderly patients with chronic respiratory disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(1): 43-47. doi: 10.7507/1007-9424.201605071 Copy

1.	吴孟超, 吴在德. 黄家驷外科学. 第7版(中册). 人民卫生出版社, 2008: 1818-1820.
2.	Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med, 2003, 10(4): 390-392.
3.	Lee BS, Hwang JH, Lee SH,et al. Risk factors of organ failure in patients with bacteremic cholangitis. Dig Dis Sci, 2013, 58(4): 1091-1099.
4.	Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am, 2000, 14(3): 521-546.
5.	黄荣柏. 急性重症胆管炎的治疗. 中国普通外科杂志, 2000, 9(2): 146-148.
6.	Chathadi KV, Chandrasekhara V, Acosta RD,et al. The role of ERCP in benign diseases of the biliary tract. Gastrointestinal Endoscopy, 2015, 81(4): 795-803.
7.	陈刚, 刘洪, CHEN Gang, 等. 2015年美国胃肠内镜学会执行委员会指南: 经内镜逆行胰胆管造影在胆道良性疾病中的作用. 临床肝胆病杂志, 2015, 31(7): 1023-1026.
8.	钟先荣, 修典荣, 覃怀成, 等. 腹腔镜与内镜治疗肝外胆管结石(附87例报道). 中国普外基础与临床杂志, 2015, 22(2): 238-240.
9.	沈焱. 老年急性重症胆管炎的治疗体会(附176例). 肝胆外科杂志, 2003, 11(6): 452-454.
10.	Han SJ, Lee TH, Kang BI,et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci, 2016, 61(7): 2094-2101.
11.	Kim JE, Cha BH, Lee SH,et al. Safety and efficacy of endoscopic retrograde cholangiopancreatograpy in very elderly patients. Korean J Gastroenterol, 2011, 57(4): 237-242.
12.	张东海, 李兆申. 中国ERCP的常见并发症及防治研究进展. 中国内镜杂志, 2002, 8(1): 32-35.
13.	Chen YK, Foliente RL, Santoro MJ,et al. Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol, 1994, 89(3): 327-333.
14.	Loperfido S, Angelini G, Benedetti G,et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc, 1998, 48(1): 1-10.
15.	Gloor B, Ahmed Z, Uhl W,et al. Pancreatic disease in the elderly. Best Pract Res Clin Gastroenterol, 2002, 16(1): 159-170.
16.	Mitchell RM, O'Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol, 2003, 36(1): 72-74.
17.	Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin North Am, 2012, 22(3): 567-586.
18.	Salminen P, Laine S, Gullichsen R. Severe and fatal complications after ERCP: analysis of 2 555 procedures in a single experienced center. Surg Endosc, 2008, 22(9): 1965-1970.
19.	刘妮, 郑则广, 陈萍, 等. 鼻咽部分泌物误吸的检测及其与老年肺炎发病的关系. 中华结核和呼吸杂志, 2015, 38(7): 1021-1022.
20.	康健. 老年吸入性肺炎的易患因素及治疗. 中国实用内科杂志, 1998, 10(18): 581-583.
21.	张志坚, 李达周, 王雯, 等. 多支架植入治疗难治性胆总管结石的随机对照研究. 中华消化内镜杂志, 2010, 27(1): 23-27.
22.	Ye X, Huai J, Sun X. Effectiveness and safety of biliary stenting in the management of difficult common bile duct stones in elderly patients. Turk J Gastroenterol, 2015, 27(1): 30-36.
23.	林秀英, 张啸, 张筱凤. 塑料内支架在难取性胆总管结石中的应用. 中国内镜杂志, 2008, 14(1): 61-63.
24.	宋丽亚, 赵清喜, 孔心涓, 等. ENBD预防胆管多发结石ERCP术后急性胰腺炎及高淀粉酶血症65例. 世界华人消化杂志, 2010, 18(16): 1724-1727.
25.	王书智, 吴军, 王淑萍, 等. 经内镜逆行胰胆管取石术后留置鼻胆管对于预防并发症的作用. 中华消化内镜杂志, 2013, 30(10): 582-584.

1. 吴孟超, 吴在德. 黄家驷外科学. 第7版(中册). 人民卫生出版社, 2008: 1818-1820.
2. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med, 2003, 10(4): 390-392.
3. Lee BS, Hwang JH, Lee SH,et al. Risk factors of organ failure in patients with bacteremic cholangitis. Dig Dis Sci, 2013, 58(4): 1091-1099.
4. Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am, 2000, 14(3): 521-546.
5. 黄荣柏. 急性重症胆管炎的治疗. 中国普通外科杂志, 2000, 9(2): 146-148.
6. Chathadi KV, Chandrasekhara V, Acosta RD,et al. The role of ERCP in benign diseases of the biliary tract. Gastrointestinal Endoscopy, 2015, 81(4): 795-803.
7. 陈刚, 刘洪, CHEN Gang, 等. 2015年美国胃肠内镜学会执行委员会指南: 经内镜逆行胰胆管造影在胆道良性疾病中的作用. 临床肝胆病杂志, 2015, 31(7): 1023-1026.
8. 钟先荣, 修典荣, 覃怀成, 等. 腹腔镜与内镜治疗肝外胆管结石(附87例报道). 中国普外基础与临床杂志, 2015, 22(2): 238-240.
9. 沈焱. 老年急性重症胆管炎的治疗体会(附176例). 肝胆外科杂志, 2003, 11(6): 452-454.
10. Han SJ, Lee TH, Kang BI,et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci, 2016, 61(7): 2094-2101.
11. Kim JE, Cha BH, Lee SH,et al. Safety and efficacy of endoscopic retrograde cholangiopancreatograpy in very elderly patients. Korean J Gastroenterol, 2011, 57(4): 237-242.
12. 张东海, 李兆申. 中国ERCP的常见并发症及防治研究进展. 中国内镜杂志, 2002, 8(1): 32-35.
13. Chen YK, Foliente RL, Santoro MJ,et al. Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol, 1994, 89(3): 327-333.
14. Loperfido S, Angelini G, Benedetti G,et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc, 1998, 48(1): 1-10.
15. Gloor B, Ahmed Z, Uhl W,et al. Pancreatic disease in the elderly. Best Pract Res Clin Gastroenterol, 2002, 16(1): 159-170.
16. Mitchell RM, O'Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol, 2003, 36(1): 72-74.
17. Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin North Am, 2012, 22(3): 567-586.
18. Salminen P, Laine S, Gullichsen R. Severe and fatal complications after ERCP: analysis of 2 555 procedures in a single experienced center. Surg Endosc, 2008, 22(9): 1965-1970.
19. 刘妮, 郑则广, 陈萍, 等. 鼻咽部分泌物误吸的检测及其与老年肺炎发病的关系. 中华结核和呼吸杂志, 2015, 38(7): 1021-1022.
20. 康健. 老年吸入性肺炎的易患因素及治疗. 中国实用内科杂志, 1998, 10(18): 581-583.
21. 张志坚, 李达周, 王雯, 等. 多支架植入治疗难治性胆总管结石的随机对照研究. 中华消化内镜杂志, 2010, 27(1): 23-27.
22. Ye X, Huai J, Sun X. Effectiveness and safety of biliary stenting in the management of difficult common bile duct stones in elderly patients. Turk J Gastroenterol, 2015, 27(1): 30-36.
23. 林秀英, 张啸, 张筱凤. 塑料内支架在难取性胆总管结石中的应用. 中国内镜杂志, 2008, 14(1): 61-63.
24. 宋丽亚, 赵清喜, 孔心涓, 等. ENBD预防胆管多发结石ERCP术后急性胰腺炎及高淀粉酶血症65例. 世界华人消化杂志, 2010, 18(16): 1724-1727.
25. 王书智, 吴军, 王淑萍, 等. 经内镜逆行胰胆管取石术后留置鼻胆管对于预防并发症的作用. 中华消化内镜杂志, 2013, 30(10): 582-584.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance of endoscopic drainage procedures selected to treat acute cholangitis of severe type in elderly patients with chronic respiratory disease

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