The Clinical Application Of ERCP In Advanced Patients With Acute Cholecystitis

Objective To evaluate the clinical application value of endoscopic retrogradecholangiopancreatography(ERCP) in advanced patients with acute cholecystitis.Tostudy and compared the clinical curative effect of endoscopicnasogallbladderdrainage(ENGBD) with percutaneous transhepatic gallbladderdrainage(PTGBD)inadvanced patients of acute cholecystitis.Method To select95cases of advanced patients with acute cholecystitis fromShenyang military region general hospital between October2011to October2013.55cases that cured by ENGBD were set as study group and40cases that cured by PTGBDwere set as controlled group. Observe and record the variation of leukocyte and totalbilirubin between two groups, study and compare the average time of operation hospitalstays curative effect and postoperative complications to find out the difference.Results Thetotaleffectiverateof55casesofadvancedpatientsofacutecholecys-titis who were taken ENGBD treatment was up to100%and the PTGBD ones was95%.The clinical manifestations of all the patients of two groups was improved significantlyand even disappeared in24hours after operation. White blood cells and total bilirubinwere dropped to normal within6days and abdomen B-ultrasonic examination impliedthat the disease had been obviously improved. Compared two groups we can find thatthe two kinds of treatments had no significant difference at average time of operation、hospital stays and postoperative long-term remission rate(p>0.05).Evaluating the effectof surgery we can find that the total effective rate of ENGBD was100%while thePTGBD ones was95%.There was no significant difference between twogroups(p>0.05).White blood cells and total bilirubin between two groups began todifference after24hours later operation(p<0.05).The postoperative complicationsbetween two groups had significant difference(p<0.05) as follows. There were 17(42.5%) patients occurred shiver and fever while no one in the ENGBD group.8(20%)patients of PTGBD group had hemorrhage in the operation while only one(1.8%)patient of ENGBD group. There were9(25%) patients of PTGBD group occurredincision infection while no one in the ENGBD group. There were12(30%)patients hadbile leakage while no one in the ENGBD group.11(27%) patients of PTGBD groupoccurred circumscribed peritonitis while no one in the ENGBD group.Conclusions ENGBDandPTGBDaretwoeffectivetherapiestocureadvancedpatients with acute cholecystitis. Although there are no significant differences betweenaverage time of operation、hospital stays and postoperative long-term remissionrate(p>0.05),but white blood cells and total bilirubin between two groups began todifference after24hours later operation(p<0.05) improving that the ENGBD groupmakes the patient’s white blood cells and total bilirubin values more significantly backto normal levels. And the PTGBD group is more prone to happen postoperativecomplications compare with ENGBD group（P<0.05）.In conclusion, ENGBD greatlyreduces the intraoperative and postoperative complications, reduces the mortality rate,greatly improving the survival rate of patient sand enables those patients who can nottake operation get timely treatment such as gall bladder decompression、sufficientdrainage of pus and alleviate symptoms of acute period. Thus we can consider thatENGBD under ERCP technology is one of the most timely safety and effectiveminimally invasive treatment methods and it is worthy of clinical popularization.