目的：探讨非X线引导下床边引流急性梗阻性化脓性胆管炎（AOSC）的临床价值。方法连续收集该院行十二指肠镜治疗AOSC的临床病例，分析在非X线引导下床边使用十二指肠镜治疗AOSC的安全性及有效性。结果在介入室行内镜逆行性胰胆管造影术（ERCP）治疗AOSC患者中，插管成功146例，插管成功率为93.6%（146/156），胆红素明显下降146例，内镜治疗成功率为93.6%（146/156），出现轻型胰腺炎、高淀粉酶血症、胆管炎和十二指肠乳头穿孔等并发症共18例，发生率为11.5%（18/156）；在非X线引导下床边行十二指肠镜治疗AOSC患者中，插管成功13例，插管成功率为86.7%（13/15），胆红素明显下降12例，内镜治疗成功率为80.0%（12/15），出现轻型胰腺炎、高淀粉酶血症和胆管炎并发症各1例，发生率为20.0%（3/15）。结论在非X线引导下床边十二指肠镜行超选胆管插管技术已经成熟，可以为部分AOSC重症患者或孕妇及不宜接受X线照射的患者解除胆道梗阻。%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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