胆道结石并胆道感染的临床分型及手术时机

目的：探讨胆道结石并胆道感染的临床分型及手术时机。方法从2011年5月至2013年5月收治的胆道结石并胆道感染患者中随机选择100例进行研究，经分型，5例为确诊型急性重症胆道感染（ACST）（确诊型ACST组），85例为轻症胆道感染（轻症胆道感染组），10例为先兆型急性重型胆道感染（先兆型ACST组）。采用SPSS 15．0统计软件进行分析，组间比较采用单因素方差分析，数据经检验方差不齐，选择多个独立样本比较的Kruskal-Wallis H检验，以P＜0．05为差异有统计学意义。结果经治疗，仅有1例患者死亡，为确诊型胆囊炎穿孔患者。比较各组的术后残石率可得，确诊型ACST组（25．0％）和先兆型ACST组（20．0％）的术后残石率显著高于轻症胆道感染组（6．0％），差异有统计学意义（χ2＝5．16， P＜0．05）；但先兆型ACST组和确诊型ACST组之间进行比较，无显著差异（P＞0．05）。三组患者之中，确诊型ACST组患者术后的住院天数、术后住ICU天数最长，显著长于其他两组（t＝11．12， t＝3．85， P＜0．05）。术后随访3～6个月，患者进行影像学检查，所有患者均未出现复发。结论临床治疗胆道结石合并胆道感染患者的时候，若患者无禁忌证，则需要对先兆型急性重型胆道感染患者进行诊断和治疗，轻症者予以彻底手术治疗，先兆型急性重型者按照实际情况给予及时的手术治疗。

Operative timing and clinical classification of biliary calculi accompanied with infection

Objective To explore the operative time and clinical classification of biliary calculi accompanied with infection .Methods 100 patients with biliary calculi and infection were treated in our hospital from May 2011 to May 2013.There were 85 patients with mild biliary tract infection （ Mild biliary infection group） , 10 patients with threatened acute severe biliary tract infection （ threatened ACST group ） , and 5 patients with acute severe biliary tract infection （ diagnosed ACST group ） .The data were analyzed by using SPSS 15.0 statistical software, including single factor analysis of variance and the Kruskal Wallis H test.A P value 〈0.05 was considered statistically significant .Results There was one death,due to acute severe biliary infection with cholecystitis perforation .In comparison, the rates of postoperative residual stones in the ACST group（25.0%） and the threatened ACST group （20.0%） were significantly higher than that of the mild biliary infection group （6.0%） （χ2 =5.16, P〈0.05）.However, there was no significant difference between the ACST group and threatened ACST group （P〉0.05）.Hospital stay and postoperative ICU stay in the ACST group were the longest among the three groups （t=11.12, t=3.85, P〈0.05）.The patients were followed up for 3-6 months, and imaging examination showed no recurrence .Conclusions In the treatment of biliary calculi accompanied with infection , patients with threatened acute severe biliary tract infection should be diagnosed if there are no contraindications and therapeutic strategy of surgical treatments should be carried out timely according to actual situation .