急性重症胆管炎的外科治疗及预后影响因素分析

Analysis of surgical treatment and prognostic factors of severe acute cholangitis

目的探讨急性重症胆管炎(ACST)的手术时机、术式选择及预后影响因素。方法回顾性分析经外科治疗的189例ACST病人的临床资料。结果入院至手术时间≤24h123例,>24h66例。手术原则均为胆道减压、胆汁引流。临床治愈163例,死亡36例,病死率19.05%。术后并发症68例。预后影响因素分析显示:年龄、术前脉搏、体温、血清胆红素、血白细胞、术前休克纠正与否、手术时机、术前合并症及术后器官功能不全为本病的危险因素。结论重视围手术期的处理,选择最佳手术时机和手术方式,对预后影响因素及时适当进行干预,可提高疗效,降低病死率。

Objective To investigate the timing of surgery, surgical procedure options and prognostic factors of severe acute cholangitis. Methods From January 1998 to December 2008,the clinical data of 189 cases with severe acute cholangitis received surgical treatment were analyzed retrospectively. Results The admission to operation time was ≤ 24 h and 〉 24 h in 123 and 66 case srespectively.The operative principles were biliary decompression surgery and biliary drainage. Clinical cure was in 163 cases and 36 died. The mortality was in 19.05%.Postoperative complications were in 68 cases. The prognostic factors analysis： age, preoperative pulse, body temperature, serum bilirubin, blood leukocytes and pre-operative shock to correct or not, the timing of surgery, preoperative complications and postoperative organ dysfunction were based disease risk factors.＂ Conclusions Attention to perioperative treatment, choice of the best operative timing and surgical procedure and for influencing prognotic factors and in time intervention would improve tberapeutie efficacy and reduce mortality.