Timing of endoscopic treatment for acute cholangitis of severe type accompanying multiple organ dysfunction syndrome / 中国微创外科杂志

Objective To investigate the timing of endoscopic treatment for acute cholangitis of severe type(ACST) accompanying multiple organ dysfunction syndrome(MODS).Methods On the basis of routine medical measures,such as oxygen inhalation and antishock treatment,9 patients with ACST accompanying MODS were given endoscopic retrograde cholangiopancreatography(ERCP) with endoscopic sphincterotomy(EST),or endoscopic nasobiliary drainage(ENBD) after needle electrode fenestration and stone removal with basket,or endoscopic retrograde biliary drainage(ERBD) with internal stent.Results The endoscopic treatment was successfully accomplished within 35 min in all the 9 patients.Seven patients at stage 1~2 of MODS rehabilitated at 1~2 weeks after treatment,while 2 patients at stage 3 of MODS died in 2 weeks.Conclusions Endoscopic treatment should be applied to patients with ACST at stage 1~2 of MODS as early as possible.For patients with ACST at stage 3~4 of MODS,however,emphasis should be laid on the prevention of organ failure and the reversion of organ functions.

Discussion of the Operative Timing and Cause of Death in the Patients with Acute Cholangitis of Severe Type / 中国医师杂志

Objective To explore the operative timing and cause of death in the patients with acute cholangitis of severe type(ACST). Methods The clinical data on the treatment and the prognosis of 116 patients with ACST were analyzed retrospectively. Results 10 cases died during perioperative period.The patients who received operation within 6 hours after toxic shock all survived.Of 8 cases who received operation after 24 hours,7cases died from toxic shock and multiple organ deficiency of function (MODF) within 4 days of post-operation. Conclusion Operation should be performed before toxic shock or mental symptom occurred in the patients with ACST. The earlier the operation was performed, and the better the prognosis was. The main causes of death were delayed operative time,severe complications and senility.

Comparison between operation through laparotomy and the endoscope for senile and high risk patients with severe acute cholangitis (report of 84 cases) / 解放军医学杂志

objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.