继发性硬化性胆管炎的临床诊治经验

Clinical analysis of diagnosis and treatment experience in 8 cases of secondary sclerosing cholangitis

目的 探讨分析反复胆道感染在继发性硬化性胆管炎病因中的作用以及引起继发性硬化性胆管炎的可能机制、临床表现和诊治经验。方法 对本科自2012-2014年收治的8例继发性硬化性胆管炎患者病史、发病原因、诊疗过程及随访预后等资料进行回顾性分析。结果 收治的8例患者均有反复胆道感染病史,其中男7例（87.5%）,女1例（12.5%）,年龄45-77岁,平均年龄51岁。均无胆道手术或其他胆道相关手术史。临床主要表现为反复、多次的胆道感染,进行性加深的黄疸,以及肝功能损害。生化指标异常主要表现为血清总胆红素升高,以直接胆红素升高为主。对上述8例患者随访2年,未见再发。结论 长期、反复的严重胆道感染是临床上继发性硬化性胆管炎的重要病因和重要病理过程,严重的胆道感染可直接引起继发性硬化性胆管炎和加重病情。临床给予利胆药物（熊去氧胆酸）通畅肝内小胆管,甲泼尼龙冲击,配合保肝护肝治疗,血清总胆红素缓慢降低。患者远期预后较其他原因引起的继发性硬化性胆管炎好。

Objective To discuss the possible mechanism, etiology, clinical manifestations, diagnosis and treatment experience of secondary sclerosing cholangitis caused by recurrent biliary tract infections. Methods Retrospectively data about process of history, etiology, diagnosis and treatment and prognosis of 8 patients with secondary sclerosing cholangitis in our department from 2012-2014 were analyzed. Results 8 cases have a history of recurrent biliary tract infections, 7 cases （87.5%） of men, 1 case （12.5%） of woman, aged from 45 to 77 years old, the average age is 51. All patients have no history ofbiliary tract surgery or other biliary surgery. The main clinical manifestations were recurrent biliary tract infection, progressive jaundice, and liver function damage. A main abnormal biochemical index is elevated serum total bilirubin, direct bilirubin increased. All the 8 patients were followed up for 2 years, and no recurrence was found. Conclusion Long-term, repeated severe biliary infection is important cause and pathological process of secondary sclerosing cholangitis. Severe biliary infection can be the direct causes of secondary sclerosing cholangitis and aggravating illness. Clinical treatments including cholagogic drug to expedite small intrahepatic bile duct, methylprednisolone pulse therapy, cooperating with protect liver treatment. Serum total bilirubin can slow down. Long-term prognosis of these patients is better than secondary sclerosing cholangitis with other causes.