Endoscopic Biliary Drainage for Severe Acute Cholangitis

Edward C.s. Lai;Francis P.t. Mok;Eliza S.y. Tan;Chung Mau lo;上达 范;Kok Tjang You;John Wong

University of Hong Kong;China Association for Science and Technology

发表时间:1992-6-11

期 刊:New England Journal of Medicine

语 言:English

U R L: http://www.scopus.com/inward/record.url?scp=0026692895&partnerID=8YFLogxK

摘要

Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment. During a 43-month period, 82 patients with severe acute cholangitis due to choledocholithiasis were randomly assigned to undergo surgical decompression of the biliary tract (41 patients) or endoscopic biliary drainage (41 patients), followed by definitive treatment. Hospital mortality was analyzed with respect to the use of endoscopic biliary drainage and other clinical and laboratory findings. Prognostic determinants were studied by linear discriminant analysis. Complications related to biliary tract decompression and subsequent definitive treatment developed in 14 patients treated with endoscopic biliary drainage and 27 treated with surgery (34 vs. 66 percent, P>0.05). The time required for normalization of temperature and stabilization of blood pressure was similar in the two groups, but more patients in the surgery group required ventilatory support. The hospital mortality rate was significantly lower for the patients who underwent endoscopy (4 deaths) than for those treated surgically (13 deaths) (10 vs. 32 percent, P<0.03). The presence of concomitant medical problems, a low platelet count, a high serum urea nitrogen concentration, and a low serum albumin concentration before biliary decompression were the other independent determinants of mortality in both groups. Endoscopic biliary drainage is a safe and effective measure for the initial control of severe acute cholangitis due to choledocholithiasis and to reduce the mortality associated with the condition. (N Engl J Med 1992;326:1582–6.), THE use of endoscopic papillotomy and nasobiliary drainage, either alone or in combination, is a satisfactory alternative to emergency exploration of the common bile duct in the treatment of patients with acute cholangitis due to choledocholithiasis.1 2 3 4 5 6 Although surgery has been the conventional treatment for these patients, remarkably low mortality rates of 4.7 and 7.6 percent have been reported in patients treated by endoscopy.1 , 4 Since these encouraging results of endoscopy were obtained in retrospective or prospective but uncontrolled studies, the advantage of endoscopic drainage remains unproved. Indeed, in a selected group of patients who had emergency surgery, we found a mortality…

相关科学

医学

文献指纹

医学与生命科学

Cholangitis

Drainage

Choledocholithiasis

Emergencies

Mortality

Biliary Tract

Decompression

Hospital Mortality

Endoscopy

Endoscopic Sphincterotomy

Surgical Decompression

Prospective Studies

Discriminant Analysis

Common Bile Duct

Serum Albumin

Nitrogen

Platelet Count

Urea

Therapeutics

Temperature

Blood Pressure

Morbidity

Serum

被引量

期刊度量

Scopus度量

年份 CiteScore SJR SNIP
1996
1997
1998
1999 7.361 10.989
2000 8.367 10.43
2001 8.571 10.65
2002 9.315 11.39
2003 10.407 13.878
2004 11.349 13.963
2005 9.888 12.13
2006 10.173 11.886
2007 10.481 11.853
2008 11.386 11.487
2009 11.765 11.932
2010 13.149 11.382
2011 56 13.674 12.685
2012 60.2 13.984 13.287
2013 58 14.796 14.706
2014 57.3 16.259 13.935
2015 57.4 16.591 13.011
2016 61.1 18.009 12.685
2017 67.2 19.476 12.908
2018 73.1 19.524 13.73
2019 66.1 18.291 13.212
2020 67.6

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