摘要
AIM: To investigate the diagnostic standard for earlyidentification of severe acute cholangitis in order to lowerthe incidence of morbidity and mortality rate.METHODS: A diagnostic standard was proposed in thisstudy as follows: documented biliary duct obstruction byultrasound or computerized tomography or other imagingtools with the manifestation of systemic inflammatoryresponse syndrome (SIRS). The surgical proceduresincluded emergency common bile duct exploration with Ttube insertion or cholecystostomy with secondary commonbile duct exploration. And incidence of postoperativemultiple organ dysfunction syndrome (MODS), duration ofsystemic inflammatory response and hospital mortality wereanalyzed.RESULTS: Fourty - three patients conforming to thediagnostic standard described above were employed in thisstudy. 1 patient was admitted in acutely ill condition andcomplicated with acute relapse of chronic bronchitis,cholecystostomy procedure was performed but the patientwas complicated with postoperative acute lung injury whiclwas treated by assisted mechanical ventilation for 5 d; 2 wllater, two- stage common bile duct Exploration and T tubeinsertion were performed. The remaining 42 patientsunderwent primary common bile duct exploration and T tubeinsertion, 1 developed acute lung injury and recovered 3 dlater, 2 patients developedl acute renal dysfunction, 1 ofwhich recovered 2 d later and the other died on d 4. For allpatients, the postoperative systemic inflammatory responsepersisted for 2 to 8 d with median of 3 d.CONCLUSION: Early diagnosis of severe acute cholangitiscan be made using this diagnostic standard, furtherdevelopment of systemic inflammatory response could beprevented and incidence of MODS as well as hospitalmortality decreased.
AIM:To investigate the diagnostic standard for early identification of severe acute cholangitis in order to lower the incidence of morbidity and mortality rate. METHODS:A diagnostic standard was proposed in this study as follows:documented biliary duct obstruction by ultrasound or computerized tomography or other imaging tools with the manifestation of systemic inflammatory response syndrome(SIRS).The surgical procedures included emergency common bile duct exploration with T tubs insertion or cholecystoatomy with secondary common bile duct exploration.And incidence of postoperative multiple organ dysfunction syndrome(MODS),duration of systemic inflammatory response and hospital mortality were analyzed. RESULTS:Fourty-three patients conforming to the diagnostic standard described above were employed in this study.1 patient was admitted in acutely ill condition and complicated with acute relapse of chronic bronchitis, cholacyatostomy procedure was performed but the patient was complicated with postoperative acute lung injury whicl was treated by assisted mechanical ventilation for 5 d;2 wi later,two-stage common bile duct Exploration and T tube insertion were performed.The remaining 42 patients underwent primary common bile duct exploration and T tube insertion,1 developed acute lung injury and recovered 3 d later,2 patients developed acute renal dysfunction,1 of which recovered 2 d later and the other died on d 4.For all patients,the postoperative systemic inflammatory response persisted for 2 to 8 d with median of 3 d. CONCLUSION:Early diagnosis of severe acute cholangitis can be made using this diagnostic standard,further development of systemic inflammatory response could he prevented and incidence of MODS as well as hospital mortality decreased.
