恶性梗阻性胆管炎29例临床分析

Malignent Obstructive Cholangitis: with Analysis of 29 Cases

我院在1978～1988年间共收治胆管及壶腹周围肿瘤162例,其中29例有恶性梗阻性胆管炎,占同期收治的胆管及壶腹周围肿瘤的17.9％,其中表现为急性梗阻性化脓性胆管炎10例。病变依次为乳头部癌、胰头癌、胆管癌和肝门部转移癌。部分伴有胆石与胆道手术史。通过B超、经皮肝穿刺胆道造影术、胆道引流术,以及逆行胰胆管造影术而确诊。对发病情况、临床特点、诊治进行了讨论。

In our hospital, there were 126 patients with neoplasms of biliary duct and periampulla of Vater, admitted in 1978-1988. Among them, 29 cases of malignent obstructive cholangitis(MOC) accounting for 17.9% of all the 162 patients were reported in this article.Pathologically, their lesions were papillary (13), pancreatic(8), biliary(7) and metastatic (1) cancers. There were 3 cases complicated with biliary stones and 2 cases have had previous biliary operations. They were diagnosed by Btype ultrasonic technique (BU), percutaneous transhepatic cholangiography (PTC) , percutaneous transhepatic biliary drainage ( PTCD ) , endoscopic retrograde cholangiopancreatography(E- RCP) and postoperative cholangiography through 'T' tube. The author considered that the operation should be performed as early as posible when MOC 'is diagnosed, particularly, in case of acute obstructive suppurative cholangitis (AOSC) . There were 10 cases of AOSC in this series. In addition, biopsy should, be adoptted during exploration of the bile duct to evade misdiagnosis of any overlooked tumours. The prognosis of MOC was very poor.Its operative complications, tumour deteriorations and the postoperative mortality in the hospital were high as well.