老年急性梗阻性化脓性胆管炎(AOSC)临床分析

目的:总结并提高老年急性梗阻性化脓性胆管炎(AcuteObstructedSuppurateCholangitis,AOSC)的诊治水平。方法:回顾性分析本院近9年收治的76例老年AOSC,对其临床特点、诊断、治疗与转归作一总结。结果:老年人的AOSC存在其不同于中青年组的特点,中毒性休克表现几率高(60.4%)。76例患者均在超声检查中有阳性发现,其中69例患者伴有至少一种全身性基础疾病。非手术治疗8例(死亡3例),手术治疗68例(急诊手术20例,择期手术48例),48例非急诊手术中行经皮经肝胆管穿刺引流(PTCD)32例,鼻胆管引流16例。结论:老年急性胆道感染进展快,在诊断上应首选辅助B超检查,减少AOSC延误诊治。治疗过程中必须加强对伴随基础病的治疗,应积极行以手术为主的解除梗阻的治疗。术前行PTCD或鼻胆管引流,可明显改善手术前全身状态,甚至使急诊手术变为择期手术。

Clinical analysis on 76 senile cases with acute obstructed suppurative cholangitis

Objective To summarize and elevate the diagnostic and therapeutic level of the senile acute obstructed suppurated cholangitis(AOSC). Method Seventy-six cases with AOSC were collected in recent 9 years,their clinical feature,diagnosis,treatment and outcome were analysed retrospectively. Results There were special characters of AOSC in senile group. The important character is that the ratio of toxic shock syndrome is higher than that of young people. Ultrasound check is accurate and simple for AOSC. There were 69 cases who companied with at least one kind of systemic severe disease. Of 76 cases, 8 cases were carried out with physical treatment, and 3 cases died among them. Emergency operations was conducted in 20 cases, and 48 cases had selective operation. There were 32 cases who had percutaneous transhepatic cholangial drainage(PTCD), and 16 cases who had nasobiliary drainage. Conclusion The symptoms in patients with AOSC may be atypical and the process is fast, and B-ultrasound check is the first choice of examinations so as to decrease the misdiagnosis and delay. In treatment, Great attention must be paid to the treatment or control of companied systemic diseases. It should be positive to have operation in order to release the obstruction or drain the bile duct as fast and effective as possible. PTCD or nasobiliary drainage before operation should be advocated as routine which can improve the general condition and make selective operation possible.