以胆管炎为首发症状的壶腹部癌的诊断及治疗

The Diagnosis and Treatment of Periampullary Carcinoma with Acute Cholangitis as the Initial Symptom.

目的:探讨壶腹部癌发生急性胆管炎的原因、诊断和治疗。方法:对25例以胆管炎为首发症状的壶腹部癌的临床表现、影像学资料及治疗方法进行回顾性分析。结果:A组先控制胆道感染,同时行影像学检查,一旦确诊并且炎症消退,即行手术治疗:B组依靠术中或术后检查确诊。所有病人均行胰十二指肠切除术,并发症发生率20％,死亡率4％。结论:影像学检查是最好的诊断方法。一旦明确诊断应尽早手术。术前控制感染,改善营养状况,保肝护肝,维持水电解质平衡至关重要,尽量避免术前鼻胆管或手术引流减压。

Objective: To discuss the reason, diagnosis and treatment of periampullary carcinoma with acute cholangitis as the initial symptom. Methods: A retrospective analysis of clinical manifestation, imaging examination and therapy of 25 patients was done. Results: In Group A acute cholangitis was treated primarily, at the same time imaging examinations were taken. Once the diagnosis was made and biliary infection was controlled, the patient was operated on. In Group B the diagnosis was depended on intraoperative and postoperative findings. All patients underwent pancreatoduodenectomy. The complica-tion rate and mortality rate were 20% and 4% , respectively.Conclusion: The imaging examinations are the diagnostic methods of choice. The patients should be operated on as soon as possible. Antibiotic, nutrition, improvement of liver function and maintenance of endo - environment are most important in the preoperative treatment. Preoperative biliary stents or surgical drainage should be avoided whenever possible.