不同梗阻类型急性化脓性胆管炎的治疗对策

Therapeutic strategy of acute suppurative cholangitis with different type of obstruction.

目的探讨对不同梗阻类型的急性化脓性胆管炎(AcuteSuppurativeCholangitis,ASC)的分型和处理,进一步重视肝内梗阻的ASC的治疗。方法回顾分析37例ASC,按不同梗阻部位分为肝外型、肝内型和混合型。单纯采用胆道探查取石T管引流30例,胆道镜取石4例,左外叶切除2例,肝吸虫病例术后口服吡喹酮。结果手术36例中,除1例肝内外胆管结石合并右叶肝脓肿,术前肝、肾功能不全,术后发生多脏器功能衰竭(MOF)要求放弃治疗外,其余35例中,术后发生MOF3例,死亡1例。术后出现胆瘘2例,胆道出血1例,34例均治愈出院。结论积极的抗休克,适当的手术时机,及时有效的胆道减压和解除梗阻是进一步提高手术治疗效果和降低死亡率的关键。

Objective To survey the classification and management of acute suppurative cholangitis （ ASC ） with different type of obstruction and to emphasize the therapy of ASC with obstruction in intrahepatic bile duct. Methods There were 37 patients with ASC who were classified to extrahepatic type, intrahepatic type and mixed type according to different obstructive position and had been analyzed retrospectively. There were 30 patients who had managed by bile duct exploration, removed the bile duct calculus and drainage with T tube, 4. patients were removed the bile duct calculus by bile duct endoscopes, and the left exite of liver in 2 patients were resected. The patients with liver flukes were treated with praziquantel. Results Except one patient with extrahepatic and intrahepatic bile duct calculus combine with right hepatic abscess, who suffered from hepatic and renal malfunction before operation and taken place multiple organ failure（MOF） , had given up to treat. There were 3 patients who taken place MOF, 1 patient died, 2 patients taken place bile fistula, 1 patient taken place hcmatobilia and 34 patients cured after operation in another 35 patients. Conclusion The key of increasing the operative efficacy and decreasing the death rate are positive countershock, appropriate opportunity of operation, biliary tract decompressing and removing the obstruction in time.