Clinical Study Of Treatment Combined Endoscopy, Laparpscopy And Intergrated Tranditional And Western Medicine For ACST

Objective: To study the most appropriate approach to treat Acute cholangitis of severe type(ACST) by endoscopy, laparoscopy and intergrated Tranditional and Western Medicine, and establish a serial standardized scheme of mini-invasive surgical treatment for ACST.Methods: From March 2003 through March 2006, 264 patients with ACST, 40 cases were randomly selected to perform emergent open bile duct exploration and T-tube drainage for case-control study. 224 cases received emergent duodenoscopic treatment for mini-invasive surgical treatment group, and completed in 219 patients. Among 219 cases treated by urgent emergent endoscopic nasobilary drainaging (ENBD) , 100 cases were randomly selected to perform exclusive urgent ENBD for case-control study. The rest cases were underwent the treatment combined urgent ENBD with Chinese traditional medicine .The study comfirmed that the Chinese traditional treatment got evidently curative effect for ACST.Among 224 cases , 5 cases with common bile duct stones didn' t complete treatment of ENBD,who received emergent laparoscopic common bile duct exploration and T-tube drainage. 18 cases removed pathogeny of ACST in acute-care phase, the rest of cases were selected to perform remove pathogeny of ACST by means of combined endoscopy and laparoscopy for mini-invasive surgical treatment. Three mini-invasive surgical schemes treated bile duct stone according to whether patients preferred duodenoscopy or laparoscopy taking outbile duct stone in mini-invasive treating group. The first string: Those patients firstly had been taken out bile duct stone by duodenoscopy,and recieved laproscopic cholecystectomy (LC), if they accompany cholecystolithiasis;or else they could go home. The second string: Those patients who misfit treatment of endoscopy taking out bile duct stone recieved laparoscopic common bile duct exploration(LCBDE). The third string: Those patients who misfit treatment of endoscopy and laparoscopy taking out bile duct stone recieved endoscopic retrograde biliary drainage(ERBD ). Three mini-invasive surgical schemes treated biliary stricture according to the stricture of kind and grade. The first string: the patients with Sphincter Oddi stricture received endoscopic sphincterotomy(EST);The second string:billiary ballon dilatation catheter and ERBD treated bile duct stricture;The third string: expandablemetallic biliary endoprosthese (EMBE) treated malignant biliary obstruction.Result: mini-invasive surgical treatment group of the 224 ACST patients, urgent ENBD was performed in 219 (97. 8%). 5 cases with common bile duct stones didn' t complete treatment of emergent.who received emergent laparoscopic common bile duct exploration and T-tube drainage,don't occur severity event. 18 cases removed pathogeny of ACST in acute-care phase . Improving of liver function and symptomatic inflammation in combined urgent ENBD with Chinese traditional medicine group better than exclusive urgent ENBD group..201 cases completed urgent ENBD and didn't remove pathogeny of ACST in acute-care phase. 160 cases with common bile duct stone, 41 cases with biliary stricture in case-control group.The bile duct stones were successfully removed after endoscopy in 115 cases, the success rate is 94.3%. 87 patients underwent LC. 35of 36 cases who didn't complete endoscopic therapy received the scheme of tri-scopy (combination of duodenoscopy , laparoscopy and choledochoscopy), the success rate is 97.2%.6 cases who misfited endoscopy and laparoscopy therapy and 2 cases who unsuccessfully completed endoscopy clearing bile duct stone,add up to 8 cases ,they received ERBD, the success rate is 100%,follow-up 4-18 months.Among 41 cases with biliary stricture,19 cases are benign strictures,22 casesare malignant strictures. 19 cases with Sphincter Oddi stricture received EST, follow-up 3-15 months, injury strictures 13 cases.10 of them who accepted billiary ballon dilatation catheter and ERBD , follow-up 7 months, successfullyf took out bilary catheter. Malignant biliary obstruction are 22 cases, 18 of them accepted EMBE , follow-up 5-19 months, 5 cases who had died exist in 8 months.CONCLUSIONS: This study involved 8 mini-invasive surgical methods. 93.3% (218/224) patients received mini-invasive surgical schemes in emergency and selective phase, mini-invasive surgical schemes have been some advantage,such as success rateN recovery faster n hospiallization. This serial scheme has expanded the scope and the success rate of mini-invasive surgery for ACST.