经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎合并感染性休克的疗效分析

PTCD for acute obstructive suppurative cholangitis associated with septic shock: analysis of the curative effect

目的评价经皮肝穿刺胆道引流（PTCD）治疗急性梗阻性化脓性胆管炎（AOSC）合并感染性休克的临床效果。方法回顾性分析2010年12月-2015年12月收治的79例AOSC合并感染性休克患者的临床资料，并总结其治疗经验。结果79例患者均行PTCD，穿刺成功率100％，无明显手术相关并发症发生。75例患者于经皮肝穿刺胆道引流管置入术后3—7d感染性休克症状消失，4例患者于住院期间死亡。75例患者中62例患者于病情稳定后根据梗阻原因行二期手术或双介入手术治疗，2例患者于病情稳定后拒绝二次手术治疗,11例患者不能二期手术或双介入手术带管生存,平均4．7个月。结论对合并感染性休克的AOSC患者行急症PTCD治疗不仅可以快速退黄减压，降低病死率，而且可以改善休克症状，为二期手术或双介入手术治疗创造机会和条件，是一种安全有效的治疗方式。

Objective To evaluate the curative effect of percutaneous transhepatic cholangial drainage （PTCD） for acute obstructive suppurative cholangitis complicated by septic shock. Methods The clinical data of 79 patients with acute obstructive suppurative cholangitis accompanied by septic shock, who were admitted to authors＇ hospital during the period from December 2010 to December 2015 to receive PTCD, were retrospectively analyzed, and the clinical experience was summarized. Results PTCD was successfully performed in all the 79 patients, the puncture success rate was 100%. In 75 patients the symptoms of septic shock disappeared within 3-7 days after PTCD, and 4 patients died during hospitalization period. For 62 patients, based on the cause of obstruction the corresponding two-stage surgeryor dualinterventional therapy was carried out after the clinical condition became stable. Two patients refused to accept the two-stage surgery after their clinical condition became stable. Eleven patients who were not suitable for two-stage surgery or dual-interventional therapy had to be living with indwelling drainage tube, the mean survival time was 4.7 months. Conclusion For the treatment of acute obstructive suppurative cholangitis accompanied with septic shock, emergency PTCD can rapidly reduce serum bilirubin level and decrease mortality, besides, it can also improve the symptoms of septic shock and, thus, create opportunities and conditions for the performance of two-stage surgery or dual-interventional therapy, therefore, emergency PTCD is a safe and effective therapy.