关键词: 胆总管结石, 急性胆管炎, 内镜下鼻胆管引流, 经内镜逆行胰胆管造影, 内镜下乳头括约肌切开术, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of endoscopic nasobiliary drainage (ENBD) in combination with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) in the treatment of patients with common bile duct stones (CBDS) and moderate-to-severe acute cholangitis (AC). Methods 63 patients with CBDS complicated with moderate-to-severe AC were enrolled in our hospital between January 2023 and January 2025, and were randomly assigned to underwent ERCP/EST in 31 cases in control, or underwent ENBD in combination with ERCP/EST in another 32 cases in observation. All patients were followed-up for six months. Serum procalcitonin (PCT) and C-reactive protein (CRP) levels were determined by fluorescence immunochromatography. Results After surgery, ambulation and hospital stay in the observation were (16.5±3.5)h and (5.1±1.6)d, both much shorter than [(25.4±4.2)h and (7.3±2.1)d, respectively, P<0.05] in the control; there was no significant difference as respect to complete stone clearance(93.8% vs. 93.5%, P>0.05); by three days after operation, serum bilirubin, ALT and AST levels in the observation group were (15.8±3.8)μmol/L, (88.6±10.5)U/L and (71.4±7.6)U/L, all significantly lower than [(33.5±6.5)μmol/L, (112.5±14.2)U/L and (97.5±8.9)U/L, respectively, P<0.05], while serum albumin level was (37.2±6.1)g/L, significantly higher than [(34.1±5.9)g/L, P<0.05] in the control; WBC count, serum PCT and CRP levels were (10.5±2.4)×10⁹/L, (1.0±0.5)ng/mL and (42.8±5.9)mg/L, all much lower than [(12.2±2.8)×10⁹/L, (2.8±0.6)ng/mL and (65.4±7.2)mg/L, respectively, P<0.05] in the control; by end of six-month follow-up, incidence of adverse effects in the two groups was not significant different (12.5% vs. 12.9%, P>0.05). Conclusion ERCP/EST plus ENBD is efficacious in dealing with patients with CBDS and AC, with rapid improvement of postoperative recovery.

Key words: Common bile duct stones, Acute cholangitis, Endoscopic nasobiliary drainage, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Therapy