新型胆道镜辅助床旁一期取石及引流术在急性重症胆管炎中的应用（含视频）

Application of digital cholangioscope‑assisted bedside one‑stage lithotomy and biliary drainage for severe acute cholangitis (with video)

摘要:

目的 评价新型胆道镜辅助的床旁一期取石及引流术在胆总管结石致急性重症胆管炎中的治疗效果。方法 回顾性分析2020年6月至2022年2月因胆总管结石致急性重症胆管炎入住东南大学附属中大医院重症监护室并接受胆道镜辅助床旁一期取石与引流的26例患者的资料，分析患者的临床转归。结果 内镜治疗距离胆管炎发病和重症监护单元入住的时间分别为（36.2±15.5）h和（7.2±4.9）h。床旁一期取石及胆道引流技术成功率均为100.0%。内镜治疗术后除1例轻症胰腺炎外，无其他内镜诊疗相关不良事件。术前急性生理与慢性健康评估（acute physiology and chronic health evaluation， APACHE）Ⅱ与序贯器官衰竭评估（sequential organ failure assessment， SOFA）评分分别为（25.2±6.6）分与（11.9±3.5）分，术后第1、3、7天APACHE Ⅱ评分分别为（21.7±6.5）分、（17.2±6.8）分和（12.7±7.7）分，SOFA评分分别为（10.6±2.9）分、（8.4±3.0）分和（5.4±3.7）分，均较术前下降（P<0.001）。患者重症监护室入住时间以及总住院时间分别为（9.7±5.0）d和（12.8±4.5）d。3例（11.5%）发生院内死亡。出院后6个月内1例患者死于肺炎，1例患者死于急性心肌梗死。其余患者无急性胆管炎再发。结论 新型胆道镜辅助的一期床旁取石与胆道引流可显著改善急性重症胆管炎预后，具有较高的安全性。

Abstract:

Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis. Methods Data of 26 patients were retrospectively analyzed, who were admitted into the intensive care unit (ICU), Zhongda Hospital, Southeast University, due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022. Clinical outcomes were analyzed. Results The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours, with 7.2±4.9 hours from ICU admission to endoscopic intervention. Technical success rate was 100.0% in one-stage stone removal and biliary drainage. Except for one mild pancreatitis, no other complication occurred. Acute physiology and chronic health evaluation (APACHE)Ⅱ and sequential organ failure assessment (SOFA) scores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5, respectively. APACHE Ⅱ scores at day 1, 3, and 7 after endoscopic intervention were 21.7±6.5, 17.2±6.8 and 12.7±7.7, respectively, and SOFA scores were 10.6±2.9, 8.4±3.0 and 5.4±3.7, respectively, all of them were lower than those before operation (P<0.001). The lengths of ICU stay and total hospitalization were 9.7±5.0 days and 12.8±4.5 days, respectively. In-hospital mortality occurred in 3 (11.5%) patients. According to a 6-month follow-up, one patient died of pneumonia, and another died of acute myocardial infarction. No acute cholangitis re-occurred in those survivors. Conclusion Newly‑designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis, highlighting its safety in managing severe acute cholangitis.