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Objective:To evaluate the safety and efficacy of endoscopic retrograde biliary drainage (ERBD) for acute obstructive suppurative cholangitis (AOSC) in the elderly.Methods:A retrospective analysis was performed on the clinical data of AOSC patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020. Patients aged 75 years and over ( n=49) were assigned to the elderly group and patients under 75 years old were assigned to the control group ( n=63). General data, American Society of Anesthesiologists (ASA) grading, procedure-related indicators, incidence of postoperative complications and mortality were compared. Results:There were significant differences in age (82.6±5.1 years VS 64.6±4.5 years, t=19.98, P<0.001), albumin levels (29.1±5.9 g/L VS 34.6±8.8 g/L, t=-3.94, P<0.001) and ASA grade ( χ2=8.37, P=0.015) in the elderly group and the control group . The elderly group were accompanied by more basic diseases, i.e. hypertension [57.14% (28/49) VS 34.9% (22/63), χ2=5.51, P=0.019], coronary heart disease [55.1% (27/49) VS 27.0% (17/63), χ2=9.14, P=0.003], chronic obstructive pulmonary diseases/asthma [24.5% (12/49) VS 6.3% (4/63), χ2=7.41, P=0.006]. There were no significant differences in the operation time (31.4±8.1 min VS 30.4±8.0 min, t=-0.61, P=0.543) or hospital stay (6.1±1.7 days VS 5.7±1.4 days, t=1.35, P=0.182). The incidences of postoperative complications were 14.3% (7/49) in the elderly group and 12.7% (8/63) in the control group, showing no significant difference ( χ2=0.06, P=0.807). No ERBD-related death was observed in either group during hospital stay. Conclusion:For elderly patients with AOSC over 75 years old, emergency ERBD, which can quickly relieve the disease, is safe and effective. Advanced age is not an absolute contraindication for emergency ERBD.
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Acute obstructive suppurative cholangitis (AOSC) is one of the common surgical acute abdomen. It often causes the increase of intrabiliary pressure due to biliary obstruction, resulting in various clinical symptoms. The onset is urgent and the disease progresses quickly. It is the primary cause of death of benign biliary diseases. Timely biliary decompression and bile drainage are the key to treat AOSC and save the lives of patients. With the continuous progress of the concept of enhanced recovery after surgery and minimally invasive technical means, minimally invasive technical means such as endoscopic retrograde cholangiopancreatography, ppercutaneous transhepatic catheterizde drainage and endoscopic ultrasound guided biliary drainage have gradually become the preferred treatment for AOSC, playing a more and more important role in the treatment of AOSC. Combined with relevant research literature and the author′s personal experience in the treatment of AOSC with these technologies, this paper introduces the application value, advantages and disadvantages of the above three minimally invasive technologies in the treatment of AOSC.
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Objective:To investigate the correlation between serum calcium level and patients with acute obstructive suppurative cholangitis (AOSC).Methods:The clinical data of 104 patients with AOSC treated in the emergency room of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2019 to February 2020 were retrospectively selected, of which 53 patients with severe sepsis were included in group A, 51 patients with simple AOSC were included in group B, and 50 patients with non infectious severe diseases hospitalized in the same period were selected as control and included in group C. The levels of serum calcium, C-reactive protein (CRP), procalcitonin (PCT) and D-dimer (D-D) were compared in the three groups. Pearson analysis was used to analyze the correlation between serum calcium and CRP, PCT and D-D.Results:The levels of serum calcium in group A were significantly lower than those in group B and group C, and the levels of inflammatory related factors CRP, PCT and D-D were significantly higher than those in group B and group C ( P<0.01), with significant difference. In AOSC group, serum calcium was negatively correlated with CRP, PCT and D-D levels ( r=-0.550, -0.479, -0.431, P<0.05). Conclusions:Patients with AOSC are prone to hypocalcemia under infection, and the level of serum calcium is negatively correlated with infection inflammatory indexes CRP, PCT and D-D, indicating that the level of calcium is related to the severity of infection. Hypocalcemia should be found in time in clinical work, and the severity of the disease should be evaluated as soon as possible.
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Objective To investigate the effects of dexmedetomidine (DEX) on the mRNA expression of triggering receptor expressed on myeloid cells 1 (TREM-1) in peripheral blood mononuclear cells of rats with acute obstructive suppurative cholangitis (AOSC).Methods Sixty healthy male Wistar rat models of AOSC induced by complete common bile duct ligation and injection of E.coli into the bile duct through an intubation tube were replicated successfully.After modeling,the peripheral blood was collected and mononuclear cells were isolated and cultured.According to random number table method,the mononeuclear cells were divided into model group (no drug added in culture of mononuclear cells) and low,medium and high dose DEX groups (final concentrations 0.4,0.8,1.2 μg/L DEX were in low,medium and high DEX mononuclear cell cultures,respectively).After the mononuclear cells were cultured for 24 hours,the levels of tumor necrosis factor-α (TNF-α),interleukins (IL-1 and IL-6) in the supernatant of the cultured mononuclear cells were detected by enzyme linked immunosorbent assay (ELISA).The level of C-reactive protein (CRP) was detected by immunity transmission turbidimetry.The expression of TREM-1 mRNA in the mononuclear cells was detected by reverse trantscription-polymerase chain reaction (RT-PCR).Results Compared with the model group,the levels of TNF-α,IL-1,IL-6,CRP were decreased,the TREM-1 mRNA expressions were down-regulated in the different DEX dose groups,and the degrees of descent in medium and high dose groups were more significant than those in low dose group [TNF-oα (ng/L):95.5±8.6,88.9±5.3 vs.131.1 ± 14.2;IL-1 (ng/L):53.5±8.3,48.3 ± 6.7 vs.73.7 ± 12.8;IL-6 (ng/L):266.9±26.2,252.1 ± 17.7 vs.349.9±40.4;CRP (ng/L):4.3 ± 1.1,3.9 ±0.7 vs.5.6 ± 1.7;TREM-1 mRNA (A value):0.43 ± 0.18,0.39 ± 0.16 vs.0.65 ±0.25,all P ＜ 0.05].Conclusion DEX can down-regulate the expression of TREM-1 mRNA and inhibit the formation and secretion of inflammatory factors TNF-α,IL-1,IL-6 and CRP in peripheral blood mononuclear cells of rats with ASOC.
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Objective To investigate the effect of the timing of endoscopic retrograde cholangiopancreatography(ERCP)treat-ment option on the respiratory burst and inflammatory factor level for acute obstructive suppurative cholangitis(AOSC)patients. Methods A total of 98 patients with AOSC who were treated in our hospital from January 2013 to June 2016 were retrospectively analyzed.The patients were divided into A group and B group according to the time of ERCP operation.42 cases in A group were received ERCP within 6 h after admission.56 cases in B group were received ERCP in 6-24 h after admission.,The serum levels of inflammatory cytokines were compared between the two groups before and after treatment.The apoptosis rate and respiratory burst rate of peripheral hematoma were compared between the two groups before and after treatment.The complications and death rate of the patients in the two groups were recorded.Results After treatment,the levels of TNF-α and IL-6 in the A group were signifi-cantly lower than those in the B group and the IL-10 level was significantly higher in the B group(P<0.05).After treatment,the rate of neutrophil apoptosis in the A group was significantly higher than that in the B group(P<0.05),and the respiratory burst level in the A group was significantly lower than that in the B group(P<0.05).The incidence number of complications and death in patients in group A was significantly lower than that in group B(P< 0.05).Conclusion ERCP treatment for patients with AOSC should be performed as early as possible and as soon as possible.Early ERCP treatment is safe and effective and can alleviate the inflammatory reaction of patients,improve the survival rate of patients,and is worthy of clinical promotion.
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Objective To investigate the therapeutic value of duodenoscopy in the treatment of acute obstructive suppurative cholangitis without X-ray guided. Methods Clinical data of acute obstructive suppurative cholangitis were collected continuously in our hospital which can be used to analyze the safety and efficacy of duodenoscopy in treatment without X-ray guided. Results 146 patients were successfully treated with ERCP in bile duct cannulation, the successful rate was 93.6 % (146/156), all the patients' bilirubin decreased, the successful rate of endoscopic treatment was 93.6% (146/156), while minor pancreatitis, hyperamylasemia, cholangitis, duodenal perforation and other complications occurred in 18 patients, the incidence rate was 11.5% (18/156). 13 patients infected with obstructive suppurative cholangtis were successfully treated with duodenoscopy without X-ray guided, and the successful rate in bile duct cannulation was 86.7%(13/15), bilirubin decreased in 12 cases, the successful rate in endoscopic treatment was 80.0%(12/15), 3 patients suffered from complications, the incidence rate was 20.0% (3/15). Conclusions The bile duct cannulation technique without X-ray guided has progressed, it can be applied to cure several patients with biliary obstruction, especially in AOSC patients, and pregnant patients, and patients who are not suitable for the X-ray radiation.
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Acute obstructive suppurative cholangitis (AOSC) is one of the most serious acute abdomen.The incidence of abdominal infection is significantly improved when patients were complicated with AOSC and diabetes mellitus,and then bile leakage,intestinal fistula and even death were induced by abdominal infection.The management of abdominal infection is very important for the prognosis of patients.One patient with AOSC and diabetes mellitus was admitted to the No.425 Hospital of PLA from May to July in 2013.Recurrent abdominal infection and abscess occurred after the operation due to his family members' refusal of surgery at early period and lax control of blood glucose before and after surgery,and then bile leakage and intestinal fistula were induced.The patient underwent operation for 3 times,and was cured after receiving fasting,gastrointestinal decompression,parental nutrition,somatostatin administration and antibiotic treatment.
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Objective To analyze the changes of bacteria stains in acute obstructive cholangitis with suppuration (AOSC) and sensitivity of different bactera strains to antibiotics in recent decade.Methods The data of bacterial susceptibility of AOSC patients and sensitivity of different bacteria strains to antibiotics in our hospital collected from 1999 to 2001 (group A,n =54) and from 2009 to 2011 (group B,n =62) were analyzed.Resules In group A,there were 29 male and 24 female with age range of 35 ～ 82 and mean age of 57.5 years,and in group B,there were 23 male and 39 female with age range of 39 ～ 87 and mean age of 68.2 years.There were no differences in bacteria strains infected between two groups.However,there was a trend of increase in the proportion of the Pseudomonas aeruginosa and Staphylococcus aureus infection,and a trend of decrease in the proportion of Escherichia coli infection.The degrees of sensitivity of Escherichia coli to ciprofloxacin,ceftazidime,cefaclor and ceftriaxone were statistically different from those observed ten years ago ; and the degrees of sensitivity of Pseudomonas aeruginosa to ceftazidime and cefaclor were statistically different from those detected ten years ago as well.In recent years,the sensitivity of bacteria to antibiotics was on a downwards trend.Conclusions The pathogens of acute obstructive and suppurative cholangitis did not obviously change in recernt decade,but the sensitivity of bacteria to antibiotics was lowered.
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ObjectiveTo explore the therapeutic method of acute obstructive suppurative cholangitis (AOSC). Methods47 patients with acute obstructive suppurative cholangitis were collected and the clinical feature,therapy methods and therapy effects were analyzed. ResultsAll the patients were accepted operation.28 patients were cured.The cured rate was 59.6%.16 patients got improvement and the rate was 34.0%.The total effective rate was 93.6%.The therapeutic effect was better.There were 3 patients died because serious septic shock and multiple systemic organ failure. ConclusionThe timely and effective operations to remove the obstruction of biliary tract,controls the infection,corrected the shock and prevent and treat complication were the key of reduce the death rate of patients.