The Efficacy Of Emergency Endoscopy In The Treatment Of Acute Obstruction Suppurative Cholangitis Caused By Extrahepatic Bile Duct Stones Was Compared With Laparoscopy Surgery

BackgroundAcute obstruction suppurative cholangitis(AOSC)is one of the most common acute abdominal diseases.In recent years,with the improvement of domestic living standard and the change of dietary habits,the incidence of AOSC is gradually increasing,especially the AOSC caused by bile duct stones is more obvious.Its clinical symptoms mainly include hyperthermia,abdominal pain,jaundice,shock and mental symptoms,etc.If the treatment is not timely or the diagnosis is delayed,the disease can further develop into sepsis,multi-organ failure and finally lead to death.Before the emergence of endoscopic therapy,conventional surgical treatments such as laparotomy and laparoscopy were widely used in AOSC patients.However,conventional surgical operations were characterized by high surgical risks,long hospitalization and high perioperative mortality.In recent years,with the rapid development of endoscopic technology and materials,ERCP has been more widely used in clinical work.Especially for elderly AOSC patients with multiple heart and lung diseases,the advantages of endoscopic treatment with less trauma and faster recovery are more obvious.ObjectiveExplore the endoscopic retrograde pancreatic angiography(ERCP)and laparoscopic surgery for the treatment of extrahepatic bile duct stones in athabasca related indicators and clinical curative effect,and study the related risk factors for prognosis of patients with athabasca,thus further guide clinical work in athabasca patients choose appropriate treatment processing,minimize damage in patients with and eventually benefit maximization.Methods48 patients with AOSC caused by extrahepatic bile duct stones admitted to our hospital from December 2016 to December 2019 were randomly selected.According to different treatment plans,they were divided into the endoscopic group and the laparoscopic group,with 25 cases in the endoscopic group and 23 cases in the laparoscopic group.Endoscopy group of patients treated with ERCP,laparoscopic group of patients treated by laparoscopic surgery,postoperative blood observation indexes including the clinical data and preoperative indicators(white blood cell count,neutrophils ratio,ALT,AST,ALP,?-GTP,total bilirubin and direct bilirubin)made,operation time,surgical blood loss,intraoperative bile bacteria culture positive cases,intraoperative calculi residual cases,surgical complications,length of hospital stay and cost of treatment,etc.Univariate analysis was performed on the relevant clinical data and test data of AOSC patients with poor prognosis,and the single factor with statistical significance was gradually incorporated into binary Logistic regression analysis to analyze the independent risk factors for the prognosis of AOSC patients.ROC curve was drawn to analyze the threshold of relevant test indicators for poor prognosis of AOSC.ResultsThere was no statistical significance in the preoperative general clinical data of the two groups(P>0.05),which was comparable.On the 3rd day after surgery,the ALT and AST of the ERCP group were significantly lower than that of the laparoscopic group(P<0.05).The total bilirubin and direct bilirubin of the ERCP group on the 5th day after surgery were lower than those of the laparoscopic group,with statistical significance(P<0.05).In terms of the average bile drainage volume of the postoperative drainage tube,ERCP was less than that of the laparoscopic operation group,showing statistical significance(P<0.05).ERCP in operation time,blood loss,postoperative wound infection,postoperative anal exhaust time,postoperative pain relief time and hospital stay were significantly lower than laparoscopic surgery group(P<0.05),while in the art of stone residue,intraoperative bile bacteria culture positive,acute pancreatitis after operation,postoperative gastrointestinal bleeding,bile leakage after operation,postoperative abdominal infection,the number of cases died after operation and hospitalization costs,differences between the two groups has no statistical significance(P>0.05).Age,body temperature,septic shock,underlying disease,time of onset,direct bilirubin,white blood cell count,neutrophil ratio and platelet count were the independent risk factors for poor prognosis in AOSC patients.When the white blood cell count was not less than 20.70*10^9/L,the proportion of neutrophils was not less than 91.85%,and the direct bilirubin was not less than 91.8umol/L,the patients with AOSC were more likely to have a poor prognosis.Conclusion(1)AOSC patients should be treated with primary endoscopy therapy after definite diagnosis.For patients with septic shock,biliary obstruction should be relieved within 6 hours of admission.(2)For elderly AOSC patients whose illness is grade III,ENBD drainage can be given at an early stage,and follow-up treatment can be carried out after the patient's condition improves.(3)Age,body temperature,septic shock,basic disease,onset time,direct bilirubin,white blood cell count,neutrophil ratio and platelet count are nine independent risk factors for poor prognosis of AOSC patients.Early prediction of the prognosis of AOSC patients is conducive to the selection of appropriate treatment.(4)When the white blood cell count was not less than 20.70*10^9/L,the proportion of neutrophils was not less than 91.85%,and the direct bilirubin was not less than 91.8umol/L,the patients with AOSC were more likely to have a poor prognosis.