急性化脓型肝胆管炎的再认识

本文报告胆石并肝胆管炎58例并分析其临床意义.发现:仅基于出现夏柯氏/雷诺氏征诊断肝内胆管炎是不妥当的,因为肝内胆管结石者较之肝外胆石有更不典型的临床表现及更复杂的病理特征.提出建立合理的诊断应基于:胆道梗阻背景,右上腹隐钝痛,寒颤发热,肝不对称肿大,早期出现内毒素血症.

CLINICAL REAPPRAISAL OF ACUTE SUPPURATIVE HEPATOCHOLANGITIS

58 cases of biliary lithiasis complicated hepatocholangitis were reported and the significance of their clinical picture was analysed. We found it is dissatisfactory to diagnose hepatocholangitis with intrahepatic bile stone only based on whether occuring Charcot's or Reynol's syndrome is present, since intrahepatic bile stone has more obscure clinical symptom and more compilcated Pathologic feature. It is reasonable to make a clinical diagnosis according to whether the following factors occured in early stage: an obstructive pathologic ground, dull or swelling pain in right upper abdomen, shaking chill and fever, a discordant megaly liver lobe amdl endotoxemia.