损伤控制理念指导老年胆道系统疾病诊治体会

Application of damage control in the treatment of biliary system diseases in elderly patients

目的探讨损伤控制(DC)理念及损伤控制手术(DCS)在老年胆道系统疾病诊治中的应用价值。方法回顾性分析2008年10月至2012年2月采取DC理念治疗的99例老年胆道系统结石患者的临床资料,其中急性梗阻性化脓性胆管炎(AOSC)46例、急性胆源性胰腺炎(ABP)12例、急性结石性胆囊炎(结石嵌顿)24例、肝内胆管结石伴急性胆管炎15例、肝脓肿4例。结果 99例患者均行DCS,手术方式包括内镜下乳头括约肌切开术(EST/EPT)、经内镜鼻胆/胰管引流术(ENBD/ENPD)、经内镜胆管塑料支架内引流术(ERBD)、经皮经肝穿刺胆管引流术(PTCD)、经皮经肝穿刺胆囊引流术(PTGBD)。所有患者均度过急性期,后续治疗采取"个体化"治疗原则,行开腹胆囊切开取石、胆道探查取石、经皮经肝胆道镜(PTCS)以及胆道镜下取石、等离子碎石、狭窄部位球囊扩张/电切治疗。治愈92例(92.9%),好转7例(7.1%),无死亡病例。结论以DC理念为指导,对高危老年胆道系统疾病患者实施DCS治疗,能分解手术风险,达到缓解甚至治愈疾病的目的。

Objective To investigate the application value of damage control（DC） concept and damage control surgery（DCS） in the treatment of biliary diseases in eldery patients.Methods The clinical data of 99 cases with severe biliary diseases who treated with the concept of DC from Oct.2008 to Feb.2012 were analyzed retrospectively,of whom,46 cases of acute obstructive suppurative cholangitis（AOSC）,12 cases of acute biliary pancreatitis（ABP）,24 cases of acute obstructive cholecystitis,15 cases of acute cholangitis with intrahepatic bile duct stones,and 4 cases of iatrogenic bile leakage.Results Ninty-nine patients underwent DCS.The surgical procedures included endoscopic sphincterotomy（EST/EPT）,endoscopic naso biliary/pancreatic drainage（ENBD/ENPD）,endoscopic retrograde biliary drainage（ERBD）,percutaneous transhepatic cholangiography drainage（PTCD） and percutaneous transhepatic gallbladder drainage（PTGBD）.All patients passed through the acute phase.The＂individual＂treatment principle was taken in the following treatment.The stones were taken out with gallbladder incision,percutaneous transhepatic cholangioscopy（PTCS）,plasma shock wave lithotripsy,balloon and electric cut,92 cases（92.9%） were cured and 7 cases（7.1%） were improved without death.Conclusion DCS can break down the risk of surgery,to relieve or even cure the disease with the guide of DC concept for old patients with severe biliary diseases.