内镜鼻胆管引流-清解灵治疗急性重型胆管炎的临床观察

作者	单位
胡家石	天津医学院天津市中西医结合急腹症研究所
吴咸中	天津医学院天津市中西医结合急腹症研究所
鲁焕章	天津医学院天津市中西医结合急腹症研究所

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中文摘要:

作者以前瞻性分组治疗对照的方法,观察了 ERBD-清解灵治疗与手术引流对急性重型胆管炎的临床疗效。ERBD-清解灵组20例,手术引流组18例。观察结果表明,治疗前患者均有胆道高压;胆汁与血中内毒素含量极高,纤维结合素、C₃水平远低于正常值,C 反应蛋白水平则高于正常值的4倍。经 ERBD-清解灵治疗后,以上指标均发生显著的变化并迅速恢复到正常水平。该组患者无并发症和死亡者。急症胆道手术引流组患者以上指标恢复很慢,有50%的患者发生心、肺、泌尿系统并发症,其中1例死亡。本文对 ERBD-清解灵治疗的机理进行了初步探讨。

英文摘要:

In order to find out an effective approach for the improvement of therapeutic results of acute cholangitis of severe type（ACST）and its therapeutic and pathophysiologic problems,clinical observation has been made.In clinical practice,38 patients with ACST were treated with ERBD and herbs（n=20）or operative drainage（n=18）.The results suggested that the pressure of bile duct in the patients was very high（20～35 cmH₂O）.There were high levels of endotoxin in bile and blood,and level of fibronectin in serum was just 25% compared to that of normal level.The value of C₃ in serum was only a half of normal level of C₃.However,a high level of C-reactive protein in serum was determined.Positive rate of E.coli in bile was 84%.From the significant differences in the series of parameters between the ERBD-herb group and the operative drainage group,it was suggested that the ERBD-herb therapy was more effective than the operative method in promoting immunologic ability,relieving symptomes of ACST,minimizing complications and decreasing mortality.Some new pathophysiologic and therapeutic concepts of ACST have been proposed.

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