Gogel H K, Runyon B A, Volpicelli N A, Palmer R C
Gastrointest Endosc. 1987 Jun;33(3):210-3. doi: 10.1016/s0016-5107(87)71560-0.
Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates. Pus was released from the common bile duct by sphincterotomy within 24 hours of admission in all 13. Stones were removed endoscopically in 10 patients (77%) without complications. After endoscopic stone removal, symptoms, signs, and abnormal laboratory values returned to normal rapidly; follow-up endoscopic retrograde cholangiography did not show retained stones. Three patients whose large stones precluded endoscopic removal underwent operative choledocholithotomy. Urgent endoscopic sphincterotomy offers an important alternative in the treatment of acute suppurative obstructive cholangitis secondary to choledocholithiasis.
内镜括约肌切开术是治疗胆总管残留结石的一种公认方法，但关于其在胆总管结石所致急性化脓性梗阻性胆管炎伴脓毒症中的应用，几乎没有具体信息。13例患有这种疾病的患者被转介给作者，考虑进行紧急内镜下胆总管减压。所有患者均被判定为手术候选不佳。13例患者均在入院后24小时内通过括约肌切开术从胆总管排出脓液。10例患者（77%）经内镜取出结石，无并发症。内镜取石后，症状、体征和异常实验室值迅速恢复正常；随访内镜逆行胆管造影未显示残留结石。3例因结石过大无法内镜取出的患者接受了手术胆管切开取石术。紧急内镜括约肌切开术为胆总管结石继发的急性化脓性梗阻性胆管炎的治疗提供了一种重要的替代方法。
