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.	?吳孟超, 吳在德. 黃家駟外科學. 第7版(中冊). 人民衛生出版社, 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.	黃榮柏. 急性重癥膽管炎的治療. 中國普通外科雜志, 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.	陳剛, 劉洪, CHEN Gang, 等. 2015年美國胃腸內鏡學會執行委員會指南: 經內鏡逆行胰膽管造影在膽道良性疾病中的作用. 臨床肝膽病雜志, 2015, 31(7): 1023-1026.
8.	鐘先榮, 修典榮, 覃懷成, 等. 腹腔鏡與內鏡治療肝外膽管結石(附87例報道). 中國普外基礎與臨床雜志, 2015, 22(2): 238-240.
9.	沈焱. 老年急性重癥膽管炎的治療體會(附176例). 肝膽外科雜志, 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.	張東海, 李兆申. 中國ERCP的常見并發癥及防治研究進展. 中國內鏡雜志, 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.	劉妮, 鄭則廣, 陳萍, 等. 鼻咽部分泌物誤吸的檢測及其與老年肺炎發病的關系. 中華結核和呼吸雜志, 2015, 38(7): 1021-1022.
20.	康健. 老年吸入性肺炎的易患因素及治療. 中國實用內科雜志, 1998, 10(18): 581-583.
21.	張志堅, 李達周, 王雯, 等. 多支架植入治療難治性膽總管結石的隨機對照研究. 中華消化內鏡雜志, 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, 張嘯, 張筱鳳. 塑料內支架在難取性膽總管結石中的應用. 中國內鏡雜志, 2008, 14(1): 61-63.
24.	宋麗亞, 趙清喜, 孔心涓, 等. ENBD預防膽管多發結石ERCP術后急性胰腺炎及高淀粉酶血癥65例. 世界華人消化雜志, 2010, 18(16): 1724-1727.
25.	王書智, 吳軍, 王淑萍, 等. 經內鏡逆行胰膽管取石術后留置鼻膽管對于預防并發癥的作用. 中華消化內鏡雜志, 2013, 30(10): 582-584.

1. ?吳孟超, 吳在德. 黃家駟外科學. 第7版(中冊). 人民衛生出版社, 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. 黃榮柏. 急性重癥膽管炎的治療. 中國普通外科雜志, 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. 陳剛, 劉洪, CHEN Gang, 等. 2015年美國胃腸內鏡學會執行委員會指南: 經內鏡逆行胰膽管造影在膽道良性疾病中的作用. 臨床肝膽病雜志, 2015, 31(7): 1023-1026.
8. 鐘先榮, 修典榮, 覃懷成, 等. 腹腔鏡與內鏡治療肝外膽管結石(附87例報道). 中國普外基礎與臨床雜志, 2015, 22(2): 238-240.
9. 沈焱. 老年急性重癥膽管炎的治療體會(附176例). 肝膽外科雜志, 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. 張東海, 李兆申. 中國ERCP的常見并發癥及防治研究進展. 中國內鏡雜志, 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. 劉妮, 鄭則廣, 陳萍, 等. 鼻咽部分泌物誤吸的檢測及其與老年肺炎發病的關系. 中華結核和呼吸雜志, 2015, 38(7): 1021-1022.
20. 康健. 老年吸入性肺炎的易患因素及治療. 中國實用內科雜志, 1998, 10(18): 581-583.
21. 張志堅, 李達周, 王雯, 等. 多支架植入治療難治性膽總管結石的隨機對照研究. 中華消化內鏡雜志, 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, 張嘯, 張筱鳳. 塑料內支架在難取性膽總管結石中的應用. 中國內鏡雜志, 2008, 14(1): 61-63.
24. 宋麗亞, 趙清喜, 孔心涓, 等. ENBD預防膽管多發結石ERCP術后急性胰腺炎及高淀粉酶血癥65例. 世界華人消化雜志, 2010, 18(16): 1724-1727.
25. 王書智, 吳軍, 王淑萍, 等. 經內鏡逆行胰膽管取石術后留置鼻膽管對于預防并發癥的作用. 中華消化內鏡雜志, 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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