重症急性胆管炎手术时机选择及围手术期并发症(附142例分析)

目的　探讨重症急性胆管炎 (ACST)病人的手术时机 ,抗生素治疗和减少围手术期并发症的重要性。方法　回顾分析 1993- 0 5～ 2 0 0 1- 0 7收治的 14 2例ACST患者的手术 ,经十二指肠镜鼻胆管引流术(ENBD)、抗生素治疗和术中胆汁细菌学培养手术治疗等情况。结果　死亡 4例 ,其中手术死亡 1例。手术治疗 137例 ,术后胆道残余结石 10例 ,术后 4 0例次出现并发症。ENBD治疗 16例均治愈。术中胆汁细菌学培养 12 3例 ,10 8例培养阳性 ,培养出细菌 98株。结论　ACST病人诊断一旦明确 ,应尽早手术。ENBD创伤小 ,胆道减压效果确实 ,亦为择期手术创造了条件 ,术中胆道镜对减少胆道残余结石十分重要 ,而细菌学培养对指导抗菌治疗有重要的意义

Management of Acute Cholangitis of Severe Type (ACST) in Operation and Complication-142 Cases Report

Objective To discuss the opportunity of operation of ACST patient and how to reduce the operative complications. Methods The clinical data of 142 cases of ACST patient from May 1993 to July 2001 were analyzed retrospectively in operation, ENBD, antibiotics therapy and pathogenic bacteria culture. Results 4 cases were died and 1 die during operation. The operation was taken in 137 cases. 10 cases had resident stone in bile duct after operation and 40 cases had complications. 16 cases received ENBD and cured. 123 cases received bacteria culture in 108 cases positive with 98 stains. Conclusion The operation should be taken once the diagnosis of ACST patient is obtained. ENBD might have less trauma and definite effect of reducing pressure in bile duct that could supply the good condition for selective operation. The choledochoscope might be important for reducing stone in bile duct. The bacteria culture could indicate the antibiotic therapy significantly.