个体化治疗决策在重症急性胆管炎中的临床意义

目的 探讨个体化治疗决策在重症急性胆管炎(ACST)中的临床意义.方法 回顾性分析2005年6月至2010年6月62例ACST的治疗效果,并发症发生率及治愈率.根据治疗的方法不同,分为两组,A组为介入/内镜治疗组,25例(40.3%),即行PTCD或EST/ENBD术;B组为手术组,37例(59.7%).结果 A组中19例(76%)在PTCD或EST/ENBD术后1周~3个月后行确定性手术;3例(12%)术后并发胆漏、胆汁性腹膜炎,其中死亡1例.B组中有32例(86.5%)行了确定性手术;5例(13.5%)行了过渡性手术,术后3个月后行确定性手术.全组治愈率98.4%,死亡率1.6%.结论 个体化治疗可有效提高ACST的治愈率.

Clinical significance of individual treatment decisions in patients with acute cholangitis of severe type

Objective To analyze the clinical significance of individual treatment decisions in patients with acute cholangitis of severe type（ACST）.Methods The treatment effectiveness,incidence rate of complication and recovery rate were analyzed retrospectively in 62 cases of ACST from June 2005 to June 2010.All of cases were divided into two groups according to the treatment type.Group A（n=25） was interventional management/endoscopic treatment,including percutaneous transhepatic biliary drainage（PTCD）,endoscopic sphincterotomy（EST） and endoscopic nasobiliary drainage（ENBD）.Group B（n=37） was operation.Results Ninteen patients（76%） of Group A underwent definitive surgery after 1 week to 3 months;3 patients（12%） developed postoperative bile leak and bile peritonitis,and one died of acute liver failure.Thirty-two patients（86.5%） of group B underwent definitive surgery;5 patients（13.5%） underwent transition operation and underwent definitive surgery after 3 months.The overall cure rate was 98.4% and mortality was 1.6%.Conclusion The individualized treatment can improve the cure rate of ACST.