急性重症胆管炎的救治体会

Experience of treatment of severe acute cholangitis

目的 :探讨急性重症胆管炎的有效治疗方法。方法 :回顾性分析 154例急性重症胆管炎( ACST)的临床资料。结果 :单纯胆总管外引流术 92例 ,死亡 10例 ( 10 .9% ) ;胆总管外引流附加胆囊造瘘或胆囊切除或肝脓肿引流术共 32例 ,死亡 6例 ( 18.8% ) ;胆道内引流术 30例 (胆肠吻合 2 4例 ,奥狄括约肌切开成形术 6例 ) ,死亡 8例 ( 2 6.7% )。全组治愈 130例 ,死亡 2 4例 ,总病死率为 15.6%。结论 :ACST诊断明确后及早手术是提高疗效的关键 ,手术方式的选择以简单、有效为原则 。

Objective:To study the effective method of treatment for the patient with severe acute cholangitis.[WT5HZ]Methods:[WT5BZ]The clinical data of 154 cases with severe acute cholangitis(ACST) were retrospectively analysed.Results: 92 cases were treated by simple choledochostomy with external drainage and 10 cases died(10.9%);six cases died(18.8%)among 32 cases by choledochostomy with esternal drainage adding cholecystotomy,or adding cholecystectomy,or adding incision and drainage of liver absess;eight cases died(26.7%) among 30 cases by internal drainage of biliary tract(24 cases by cholangio enterostomy,6 cases by incision and plastic operation of Oddis sphincter).24 cases died in all 154 cases with the overall fatality rate was 15.6%.[WT5HZ]Conclusion:[WT5BZ] It is the key to elevating the therapeutic effectiveness to early operate after the diagnosis of ACST being made.The principle of selection of operative procedure is simple and effective.The major measure of improving prognosis is to actively prevent and cure shock and multiple organ failure.