源头控制用于中重度急性胆道感染治疗

Clinical application of source control for surgical infection in the management of moderate-severe acute infection of biliary tract

目的探讨源头控制原则在中重度急性胆道感染治疗中的应用价值。方法回顾性分析2004年1月至2014年6月应用外科源头控制原则处理的48例因胆石病、胆道肿瘤所致中重度急性胆道感染病人的临床资料。结果急性胆囊炎20例行经皮经肝胆囊穿刺引流术，急性胆管炎28例中6例行内镜十二指肠乳头括约肌切开术＋内镜鼻胆管引流术（endoscopic naso-biliary drainage，ENBD），21例行ENBD，1例行胆管内支架置入术。引流术后病人寒战、发热、腹痛、腹膜炎等症状、体征迅速缓解，感染中毒症状得到有效控制，肝功能渐趋正常。全组未出现并发症，无死亡病例。结论应用源头控制原则处理中重度急性胆道感染安全、微创、有效、并发症少，为后续进一步治疗创造了有利条件，具有重要的临床应用价值。

Objective To explore the values of source control for surgical infection in the management of moderate-severe acute biliary tract infection. Methods A retrospective study was conducted for 48 patients with moderate-severe acute infection of biliary tract from cholelithiasis or biliary tract tumor. And source control for surgical infection was implemented from January 2004 to June 2014. Results Twenty cases of acute cholecystitis underwent percutaneous transhepatic gallbladder drainage. Among 28 cases of acute cholangitis, endoscopic sphincterectomy plus endoscopic naso-biliary drainage （ENBD） （n = 6） and ENBD alone （n = 21） were performed. One case of biliary tract tumor was treated by bracket in bile duct. Chills, fever, abdominal pain and peritonitis were quickly relieved, symptoms of infection controlled and liver function restored to normal. There was neither complication nor mortality. Conclusions Source control for surgical infection is essential in the man- agement of moderate-severe acute infection of biliary tract. And it offers multiple advantages of safety, mini invasiveness, efficacy and fewer complications. It can provide satisfactory conditions for further treatment and has important clinical values for-moderate-severe acute infection of biliarv tract.