壶腹部癌合并急性胆管炎的治疗选择

目的　探讨壶腹部癌合并急性胆管炎的治疗方法。方法　对比分析 12年间收治的壶腹部癌合并急性胆管炎的临床资料。其中采用一期切除手术 2 5例 ,先作胆道引流二期行切除手术 12例。结果　一期手术组通过非手术治疗 ,术前的体温和白细胞均比入院时明显降低 (P <0 .0 5 ) ,基本达到二期手术组二期切除的术前水平 ( P >0 .0 5 ) ,而总胆红素和清蛋白水平无明显变化 ;与二期组比较 ,一期组切除术前准备期明显缩短 (P <0 .0 5 ) ,手术时间和术中出血量减少 ,虽然术后感染性并发症发生率和术后住院天数增加 ,但再手术率和手术死亡率相似。结论　壶腹部癌合并急性胆管炎可先给予非手术治疗 ,待胆道感染控制后一期行胰十二指肠切除术

Selection of treatment for periampullary carcinoma complicated with acute cholangitis

Objective To evaluate the therapeutic approach for patients with periampullary carcinoma (complicated) with acute cholangitis. Methods A comparative analysis of the clinical data of cases of (periampullary) carcinoma with acute cholangitis who were admitted and treated in our hospital during a 12-year period.They included 25 cases who underwent primary resection, and 12 cases who underwent a two-stage resection with initial bile duct drainge. Results After conservative procedures, the preoperative temperature and WBC of patients in primary resection group were much lower than when admitted(P<0.05), and were similar to the preoperative level of the two-stage resection group at the time of the second stage resection(P>0.05). Total bilirubin and albumin levels showed no significant changes. Compared with the two-stage resection group,the primary resection group had shorter preoperative preparation time, shorter operation time, lesser intra-operative blood loss, but higher postoperative infection complication rate and prolonged length of hospital stay(P<0.05). There were no statistical differences in reoperation rate and mortality rate between the two groups(P>0.05). Conclusions Patients with periampullary carcinoma complicated with acute cholangitis can initially be treated conservatively . After biliary infection is controlled, primary (pancreatoduodenectomy) is performed.