CAJ | 학술논문

目的：探讨胆总管结石相关急性化脓性胆管炎的内镜、腹腔镜联合治疗方案的安全性、有效性、可行性。方法2009年1月至2013年10月，前瞻性观察、分析312例胆总管结石相关急性化脓性胆管炎患者接受分阶段内镜、腹腔镜联合治疗情况。急性化脓性胆管炎第一阶段治疗（急性期）首选内镜逆行胰胆管造影（ERCP）伴内镜鼻胆管引流（ENBD），经皮肝穿刺胆管引流（PTBD）作为 ERCP失败的选择；第二阶段治疗（平稳期），根据胆管结石病情特点实施内镜、腹腔镜及联合治疗。结果312例急性化脓性胆管炎患者中307例急性期病情得到控制，生存率98.4%。其中急诊 ERCP 组296例、急诊 PTBD 组16例，两组治疗成功率分别为94.9%和100%（P =1.000），并发症发生率分别为5.4%和6.3%（P =0.601），死亡率分别为1.3%和6.3%（P =0.233）。急诊内镜下乳头肌切开、择期内镜下乳头肌切开、腹腔镜胆总管探查、开腹胆管探查四种方式成功清除胆总管结石278例，4组治疗成功率（P =0.327）、并发症发生率（P =0.653）差异均无统计学意义；4组患者住院时间差异有统计学意义，急诊内镜下乳头肌切开组住院时间最短[（6.0±1.7）d]，开腹胆管探查组住院时间最长[（14.3±4.6）d]。结论分阶段内镜、腹腔镜联合方案治疗胆总管结石相关急性化脓性胆管炎安全、有效、可行。
목적：탐토담총관결석상관급성화농성담관염적내경、복강경연합치료방안적안전성、유효성、가행성。방법2009년1월지2013년10월，전첨성관찰、분석312례담총관결석상관급성화농성담관염환자접수분계단내경、복강경연합치료정황。급성화농성담관염제일계단치료（급성기）수선내경역행이담관조영（ERCP）반내경비담관인류（ENBD），경피간천자담관인류（PTBD）작위 ERCP실패적선택；제이계단치료（평은기），근거담관결석병정특점실시내경、복강경급연합치료。결과312례급성화농성담관염환자중307례급성기병정득도공제，생존솔98.4%。기중급진 ERCP 조296례、급진 PTBD 조16례，량조치료성공솔분별위94.9%화100%（P =1.000），병발증발생솔분별위5.4%화6.3%（P =0.601），사망솔분별위1.3%화6.3%（P =0.233）。급진내경하유두기절개、택기내경하유두기절개、복강경담총관탐사、개복담관탐사사충방식성공청제담총관결석278례，4조치료성공솔（P =0.327）、병발증발생솔（P =0.653）차이균무통계학의의；4조환자주원시간차이유통계학의의，급진내경하유두기절개조주원시간최단[（6.0±1.7）d]，개복담관탐사조주원시간최장[（14.3±4.6）d]。결론분계단내경、복강경연합방안치료담총관결석상관급성화농성담관염안전、유효、가행。
Objectives To determine the safety,efficacy and feasibility of a combined endoscopic-laparoscopic treatment of acute suppurative cholangitis(ASC) caused by common bile duct stones. Methods This study was a prospective analysis of a total of 312 patients with ASC caused by common bile duct stones between January 2009 and October 2013. All patients in acute stage of ASC undergwent emergency endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous biliary drainage(PTBD)was performed if ERCP failed. The patients in stable stage of ASC were treated by combined endoscopic -laparoscopic technique according to the characteristic of common bile duct stones. Results 307 patients with ASC acute condition were under control,and survival rates was 98.4%(307/312). All patients underwent biliary drainage by ERCP(n=296)or PTBD(n=16). Comparing the outcomes between emergency ERCP and PTBD,there were no statistically significant differences in terms of success rate (94.9% vs 100%,P = 1.000),complication rate(5.4% vs 6.3%,P = 0.601),and mortality(1.3% vs 6.3%, P = 0.233). 278 patients with ASC were successfully removed extrahepatic bile duct stones by four types of technique:emergency endoscopic sphincterectomy (EST),selective EST,laparoscopic common bile duct exploration (LCBDE),open common bile duct exploration (OCBDE). There were no statistically significant differences among four groups in terms of success rate (P = 0.327)and complication rate (P = 0.653). The length of hospital stay in emergency EST was shortest,compared among 4 groups,and it was longest in OCBDE group. Conclusion A combined endoscopic-laparoscopic technique in two-stages treatment of ASC caused by common bile duct stones is safe,effective and feasible.