急性梗阻性化脓性胆管炎112例治疗体会

Management of 112 Cases of Severe Acute Obstructive Suppurative Cholangitis

目的:探讨急性梗阻性化脓性胆管炎(AOSC)的病因及诊治方法,探讨AOSC病人的死亡原因及手术时机。方法:回顾性分析112例AOSC病人的治疗及预后情况。结果:死亡8例,其中手术治疗死亡2例。早期大剂量使用地塞米松治疗的病人休克得到纠正率(80.9%,17/21),明显高于未用地塞米松的病人(33.33%,2/6)。结论:AOSC病人应在出现五联征之前手术,对于已出现休克的病人,应先给予适当的保守治疗,病情稳定后再手术;贻误手术时机、严重并发症、高龄是手术死亡的主要原因;应早期大剂量应用地塞米松治疗AOSC。同时中医利胆利胰、活血化淤治疗有利于急性梗阻性化脓性胆管炎的患者的转归。

Objective To explore the reason of death and timing of operation of patients with AOSC.Methods Retrospective analysis was made on the treatment and prognosis of 112 patients with AOSC.Results Of 112 patients,8 died with death rate of 7.14%.There are 2 died fromsurgical management.Of 21 patients treated with dexamethasone,there are 17 patients whose shock were corrected, while of 6 patients who were not treated with dexamethasone,only 2 patients＇shock 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 postponed in these cases until the shock is controlled o Missing the time of operation, being older age and serious complication are the major reasons of death. The early use of massive dose ofdexamethasone is very important to the patients with AOSC.And Shugan Lidan and Huoxue HuaYu of Chinese medicine used in the patients with acute obstructive purulent cholangitis have relatively satisfying outcomes.