124例急性重症胆管炎诊治体会

【摘要】 目的 介绍急性重症胆管炎治疗体会。方法〓回顾性分析我院2008~2013年收治124例急性重症胆管炎患者的临床资料。结果〓手术治疗组112例,109例痊愈,其中81例术后一个月拔除T管痊愈出院,4例因肝内胆管残留结石二期行肝切除术,肝内胆管及胆总管有残石14例,胆总管有残石6例二期手术行经T管胆道镜取石痊愈,PTCD(经皮经肝穿刺胆管引流术)2例,ENBD(经鼻胆管引流)2例。手术后死亡3例,其中1例PTCD后因多器官功能衰竭而死亡,2例胆囊造瘘术后因感染性休克而死亡。非手术组12例中有8例采取保守治疗成功后行二期手术痊愈,4例因多器官功能衰竭而死亡。结论〓急性重症胆管炎应早期诊断,手术治疗是首选方案,应选择快速、简单、有效的手术方法。

Experience in diagnosis and treatment of 124 cases with severe acute cholangitis

【Abstract】 Objective〓To report the experience in diagnosis and treatment of severe acute cholangitis. Methods〓A retrospective analysis of the clinical data of 124 cases of patients with acute severe cholangitis treated in our hospital from 2008 to 2013 were performed. Results〓112 cases underwent the surgical treatment, of which 109 cases were cured. In cured patients, 81 cases were performed by T tube drainage, 4 cases received the two stage hepatectomy because of intrahepatic bile duct residual stone, 14 cases underwent two stage operation due to residual stone in both intrahepatic bile duct and common bile duct and 6 cases in the common bile duct alone, 2 cases were performed PTCD, 2 cases were performed ENBD (nasal biliary drainage). Three cases died in operation patients, including MODS after gallbladder fistula in one case, septic shock after PTCD in two cases. Twelve patients received conservative treatment, and 4 cases died. Conclusion〓Early diagnosis and early operation treatment the most step for acute severe cholangitis. Quick, simple and effective approaches are optional surgery.