Objective To summarize the therapeutic efficacy of laparoscope， duodenoscope， and choledochoscopein treatment for elderly patients with common bile duct stones associated with acute severe cholangitis. Methods Eighty-six patients with common bile duct stones associated with severe acute cholangitis from May 2008 to December 2012 in this hospital were chosen. The operation methods and their therapeutic efficacy were analyzed. Results ① Thirty-one patients were performed by laparoscopic cholecystectomy （LC） plus common bile duct discission combined with choledo-choscope for removing the stones， which were completely successful. One case of bile duct perforation happened. The total effective rate was 96.77%（30/31）. The hospital stay was （9.05±2.11） d， the hospital costs was （1.47±0.34） ten thousand yuan. ② Forty-three patients were performed by LC combined with duodenoscopic papillotomy， 42 patients were successful，one patients was turned to the other operation， the retained calculus was found in two patients. The total effective rate was 97.67%（42/43）. The hospital stay was （8.64±1.20） d， the hospital costs was （2.36±0.62） ten thousand yuan. ③ Twelve patients were performed by endoscopic nasobiliary drainage and LC plus common bile duct discission combined with choledochoscope for removing the stones， which were completely successful. The total effective rate was 91.67%（11/12）. The hospital stay was （11.06±2.33） d， the hospital costs was （2.79±0.41） ten thousand yuan. No severe complications such as intestinal perforation， hemorrhea， and severe acute pancreatitis and no death happened. Conclusions Three-endoscopy in treatment for elderly patients with common bile duct stones associated with severe acute cholangitis has a good therapeutic efficacy， a suitable operation is chosen according to the different conditions of the patients， the success rate is high， the complication rate and the mortality rate are low.
【摘要】目的 探讨急性重症胆管炎(ASC)患者的手术时机、治疗方式的选择以及患者围手术期的治疗。方法 回顾性分析156例ASC患者的临床资料。结果 治愈131例，死亡25例，总死亡率为16.0%。入院后行急诊手术者32例，术后死亡9例，死亡率28.1%； 入院后经支持治疗、纠正休克和酸碱失衡及抗感染治疗后再行手术者53例，死亡9例，死亡率为17.0%。行ERCP+乳头括约肌切开术治疗17例,行PTCD 治疗12例,行保守治疗42例。结论 对ASC患者掌握好手术时机，根据病情选择治疗方式，重视围手术期支持治疗以及适时手术治疗，是降低死亡率，提高疗效的重要措施。
Objective To evaluate the relationship between endothelin (ET) in bile and peripheral blood with systemic and hepatobiliary injury in patients with acute cholangitis of severe type (ACST). Methods ET, ALT and total bilirubin in bile and peripheral veinous blood of 25 patients with acute cholangitis of severe type (ACST) were detected during operation, one week and two weeks after operation. Results The contents of ET, ALT and total bilirubin were significantly lower on 7-day and 14-day after operations as compared with that during operations (Ｐ＜0.05 and Ｐ＜0.01). The concentration of ET in peripheral veinous blood paralleled with that in bile. Conclusion This suggests that ET is tightly related with the pathologic process of ACST. So, in patients with ACST, the dynamic measurement of ET in peripheral veinous blood can be an index for judging the degree of pathological damage either to the hepatobiliary or systemic systems.