APACHE-Ⅱ评分与胆道控制性手术在急性化脓性胆管炎中应用的研究

Retrospective study of acute suppurative cholangitis using biliary tract control operation with APACHE-Ⅱ score

目的探讨使用急性生理和慢性健康状况评价（APACHE）-Ⅱ评分指导急性化脓性胆管炎急诊手术决策的可行性及意义，提出急性化脓性胆管炎行控制性手术的指征。方法采用回顾性研究的方法，对244例急性化脓性胆管炎接受急诊手术的患者，根据入院时的APACHE-Ⅱ评分分值分为两组，再分别将两组采用胆道控制性手术（BTCO）治疗的患者和常规确定性手术治疗的患者进行对照。将APACHE-Ⅱ评分〉15分者作为A组，采用BTCO63例，确定性手术110例，将APACHE-Ⅱ评分≤15分者作为B组，采用BTCO29例，确定性手术42例，比较两组术后病死率和并发症发生率。结果A组中BTCO术后病死率（4．8％）和并发症发生率（6．3％）明显低于确定性手术（8．2％、10．0％），差异有统计学意义（P〈0．05）。B组中BTCO术后病死率和并发症发生率与确定性手术比较，差异无统计学意义（P〉0．05）。结论APACHE-Ⅱ评分可以用于指导急性化脓性胆管炎患者急诊手术决策。APACHE-Ⅱ评分≤15分者，可行确定性手术；APACHE-Ⅱ评分〉15分者，以采用BTCO为宜。

Objective To investigate the feasibility and evaluation of APACHE- Ⅱ score in order to promote emergency surgery for the patients with acute suppurative cholangitis. Methods A matched retrospective study was made on 244 patients with acute suppurative cholangitis who were divided into group A （APACHE-Ⅱ score 〉 15 scores） and group B （APACHE- Ⅱ score≤ 15 scores）. It was performed that 110 primary definitive operation and 63 biliary tract control operation in group A ,and 42 definitive operation and 29 biliary tract control operation in group B. Postoperative complications and mortality rate were compared between two groups. Results Postoperative complications （6.3%） and mortality rate （4.8%） were significantly lower at biliary tract control operation patients than those （10.0% ,8.2% ） at definitive operation in group A （P 〈 0.05 ）. There was no statistical difference at two operative methods in group B （P 〉 0.05 ）. Conclusions APACHE-Ⅱ score can be used to direct the emergency operative strategy on the patients with acute suppurative cholangitis. Biliary tract control operation should be performed in patients with acute suppurative cholangitis whose APACHE-Ⅱ score is over 15 scores.