急性梗阻性化脓性胆管炎135例

Management of acute obstructive suppurative cholangitis

目的探讨急性梗阻性化脓性胆管炎（AOSC）病人的死亡原因、手术时机及药物治疗的作用。方法回顾性分析2001年2月至2006年3月135例AOSC病人的治疗及转归情况。结果死亡15例。其中手术治疗死亡7例（7／102），保守治疗死亡8例（8／33）。≥60岁者死亡11例（11／58），〈60岁者死亡4例（4／77）。早期短时使用地塞米松和鸟司他丁治疗的病人休克及中毒症状得到纠正40例（40／46），明显高于未用者11例（11／22）。结论AOSC病人应在出现五联征之前手术，已出现休克的病人易短时适当纠正后及时手术治疗；贻误手术时机，严重并发症、高龄是死亡的主要原因；早期使用地塞米松和乌司他丁针剂是抗休克的一种良好措施。

Objective To explore the reason of death and timing of operation in patients with AOSC. Methods Retrospective analysis was made on the treatment and prognosis of 135 patients with AOSC from 2001 to 2006. Results Of 135 patients, 15 died with death rate of 11.1%. There were 7 died from surgical management. Of 46 patients treated with dexamethasone and ulinasatin, there were 40 patients whose shocks were corrected,while of 22 patients who were not treated with dexamethasone and ulinasastin only 11 patients＇ shocks were corrected. Conclusion Surgical treatment should be done before shock or/and mental confusion was found in patients with AOSC. Medical treatment should be given first to patients complicated with shock. Surgery should be not postponed in these cases until the shock is controlled. Missing the time of operation being order age and severe complications are the major reason of death. The early use of massive dose of dexamethason and ulinasastin is very important for the patients with AOSC.