IS NASOBILIARY DRAINAGE UNNECESSARY FOR DRAINAGE OF ACUTE SUPPURATIVE CHOLANGITIS? OUR EXPERIENCE
IS NASOBILIARY DRAINAGE UNNECESSARY FOR DRAINAGE OF ACUTE SUPPURATIVE CHOLANGITIS? OUR EXPERIENCE
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DOI：
10.1111/j.1443-1661.2010.00959.x
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发表时间：
2010-07-01
影响因子：
5.3
通讯作者：
Hirooka, Yoshiki
中科院分区：
文献类型：
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作者：
Kawashima, Hiroki;Itoh, Akihiro;Hirooka, Yoshiki
两项比较内镜鼻胆管引流（ENBD）和内镜内胆管引流（内部EBD）治疗急性化脓性胆管炎（ASC）的随机对照试验显示，疗效无显著差异，且两者均首选内部EBD而非ENBD。在这项研究中，ENBD的必要性进行了重新审查。在过去的五年中，59例患者在我们的研究所接受了ASC的紧急内窥镜手术。如果需要引流，我们选择内部EBD作为首选，ENBD用于预测有早期梗阻或胆管逆行感染的患者。对ENBD的发生率、选择ENBD的原因以及引流的有效性进行回顾性检查。在59例患者中，40例患者在未引流的情况下完全取出结石，5例患者在未取石的情况下进行了内部EBD和2例ENBD，5例患者在取石后进行了内部EBD和7例ENBD。在白色血细胞计数和直接胆红素水平方面，ENBD和内部EBD患者之间没有观察到显著差异。ENBD主要适用于多发性胆管狭窄、出血倾向及脓性胆汁过多的患者。尽管内引流适用于许多ASC患者，但ENBD在某些患者中是必要的。
Two randomized controlled trials comparing endoscopic nasobiliary drainage (ENBD) and internal endoscopic biliary drainage (internal EBD) for acute suppurative cholangitis (ASC) showed no significant difference in efficacy and both preferred internal EBD to ENBD. In this study, the necessity of ENBD was re-examined. Over five years, 59 patients underwent an emergency endoscopic procedure for ASC in our institute. If drainage was needed, we selected internal EBD as a first choice and ENBD was used in patients predicted to have early obstruction of the tube or retrograde infection of the bile duct. The rate of ENBD, for which reason ENBD was selected, and the efficacy of drainage were examined retrospectively. In the 59 patients, 40 patients had the stones completely removed without drainage, five internal EBD and two ENBD were performed without removal of stones and five internal EBD and seven ENBD were performed after removal of stones. In terms of white blood cell count and direct bilirubin level, no significant difference was observed between ENBD and internal EBD patients. ENBD was mainly selected for the patients with multiple biliary strictures, hemorrhage tendency and excessive purulent bile. Even though internal drainage is suitable in many ASC patients, ENBD is necessary in selected patients.