急性重症胆管炎63例治疗体会

目的探讨急性重症胆管炎（ACST）的手术时机、手术方式与死亡原因。方法回顾性分析1995年8月-2005年5月收治的急性重症胆管炎63例。结果死亡10例，总病死率15．9％；其中手术治疗52例，死亡6例，病死率11．5％；非手术治疗11例，死亡4例，病死率36．4％。死亡原因为多系统器官功能衰竭（MSOF）5例，感染性休克3例，DIC1例，心梗1例。结论重视术前准备并根据患者的不同情况，选择恰当的手术时机及手术方式是救治的关键；手术应力求简单、安全、有效。对于肝外型ACST，可慎重选择内引流术；严重的并发症、延误手术时机、术式不当、术前准备欠充分、高龄及并存病是死亡的主要原因。

Management of 63 patients of acute cholangitis of severe type

Objective] To investigate the best time of operation,method of operation and the causes of death in patient with ACST.Method] Retrospective analysis was made on the treatment and prognosis of 63 patients with ACST from August 1995 to May 2005.Result] Of 63 patients,10 died,with a death rate of 15.9%.The rest 52 patients were on surgery treatment,6 patients died with death rate 11.5%.For the group of 11 patients whithout getting surgery,4 died,with a death rate of 36.4%.The main death cause were multiple system organ disfunction(5 cases),infective shock(3 cases),DIC(1 case),myocardial infarction(1 case).Conclusion] Respecting the preparation before operation and proper selection of the time and method of the surgery treatment according to different conditions of the patients is the key to rescue.The operation should be simple,safe and valid,and the internal drainage can be selected cautiously on ACST of outer liver.Severe complication,missing the time of operation,improper surgery treatment,deficient preparation before operation,being older age and intercurrent diseases are the major causes of death.