急性重症胆管炎的处理策略

Treatment strategies for acute severe cholangitis

急性重症胆管炎病情凶险,进展迅速,死亡率高,目前仍是胆道外科的治疗难题。早期明确诊断后,及时解除胆道梗阻引起的胆管内高压,阻断细菌和毒素入血触发炎症"瀑布反应"是治疗的关键。黄志强院士提出的"解除梗阻、去除病灶、通畅引流"十二字方针,至今仍是急性胆管炎的治疗准则。积极胆道引流,及早连续性肾脏替代治疗,同时予以抗菌治疗及多器官功能支持,可显著改善疾病转归,降低死亡率。

Acute severe cholangitis is a serious disease with fast development and high mortality.The therapeutic options are stills limited.Once diagnosed,the key step of treatment is to timely reduce the high pressure of bile duct caused by biliary obstruction,and to block bacteria and toxins from entering the blood,which might trigger inflammation"cascade reaction".The policy of"relieve obstruction,remove lesions,and bile duct drainage"raised by academician Huang Zhiqiang,is still the criterion for acute cholangitis treatment.Active biliary drainage,early continuous renal replacement therapy,and simultaneous antibacterial therapy and multi-organ function support can significantly improve the disease outcome and reduce mortality.