急性胆管炎诊断与治疗的进展及展望

Advances and Perspectives in the Diagnosis and Treatment of Acute Cholangitis

急性胆管炎是一种常见的外科急腹症,其主要是因胆道结石和胆道梗阻引起。早期若不能及时明确诊断并给予有效治疗,它可能会迅速进展为感染性休克或造成多器官功能衰竭,甚至导致患者死亡。作为良性胆道疾病的主要致死原因,急性胆管炎是一种潜在的全身感染性疾病。《东京指南2007》(TG07)是最早发布、也是最广泛认可的急性胆道感染诊治指南。该指南在2013年(TG13)和2018年(TG18)进行了修订。TG13和TG18在急性胆囊炎和急性胆管炎的诊断方面没有改变,但在治疗方面,微创技术的重要性日益提升。而早期诊断、早期胆道引流以及早期适当的治疗是降低急性胆管炎死亡率的关键。本研究在检索国内外相关文献的同时,结合东京指南作为重要参考依据,将急性胆管炎各个方面的最新研究进展,如病因及发病机制、临床症状及诊疗手段等进行总结归纳和分析,并对今后的临床诊治策略进行讨论,以便于应用于临床,为临床医师在胆管炎的诊治过程中提供参考。

Acute cholangitis is a common surgical emergency abdomen, which is mainly caused by bile duct stones and biliary obstruction. In the early stages, if not diagnosed promptly and treated effectively, it may rapidly progress to infectious shock or cause multi-organ failure, or even lead to patient death. As the leading cause of death in benign biliary diseases, acute cholangitis is a potentially systemic infectious disease. The Tokyo Guidelines 2007 (TG07) were the first published and most widely recognized guidelines for the diagnosis and management of acute biliary tract infections. The guidelines were revised in 2013 (TG13) and 2018 (TG18). TG13 and TG18 remain unchanged in terms of the diagnosis of acute cholecystitis and acute cholangitis, but the importance of minimally invasive techniques is increasing in terms of treatment. And early diagnosis, early biliary drainage, and early appropriate treatment are the keys to reducing mortality in acute cholangitis. In this study, we searched the relevant literature at home and abroad, combined with the Tokyo Guide-lines as an important reference basis, summarized and analyzed the latest research progress in various aspects of acute cholangitis, such as the etiology and pathogenesis, clinical symptoms and diagnostic and therapeutic means, and discussed future clinical diagnostic and treatment strate-gies, so as to facilitate their application in the clinic, and to provide references for the clinicians in the process of diagnosis and treatment of cholangitis.