急性梗阻性化脓性胆管炎——附297例临床分析

急性梗阻性化脓性胆管炎的感染严重,病死率高,及时采取正确措施十分必要,本文讨论了发病原因及手术选择。

ACUTE OBSTRUCTIVE SUPPURATIVE CHOLANGITIS(Attached clinical analysis to 297 cases)

297 patienes with acute obstructive suppurative cholangitis (AOSC) were analyzed. 70 of the cases were senile AOSC, and in 26 cases the- AOSC was intrahe-patic. The clinical manifestations in 123 cases consisted mainly of the Charcot's syndrome, and the remaining 174 cases had in addition mental confusion or/ and shock. Serious complications consisted of toxic shock, acute renal failure, acute hepatic failure,acute general peritonitis, septicemia and bacterial liver abscess. Various biliary drainages were used in treatment. The mortality of the whole sense was 22.05%. The postmortem examination was performed in 4 and in 3 of them retained intrahatic duct stone were found accompanied by suppurative infection, liver abscess, and septicemia.AOSC is intracholangeal suppurative infection under pressure due to nearly complete obstuction of the biliary tract with serious complications and very high mortality. Urgent early diagnosis is exceedingly important for correct treatment in time. In general acure cholangitis should be looked upon as AOSC and treated in time without waiting for the appearance of mental confusion and shock. Relief of biliarytract obstruction with efficient decompression of the biliary tract above the obstruction are the fundemental therapeutic measures for AOSC In this respect, senile AOSC and intrahepatic AOSC sometimes atypical clinically demands special attention. B-ultrsonography before operation may be of great help in diagnosis. At operation asymmetric hepatomegaly and perihepatitis are suggestive and direct puncture of the hepatic duct may be recommended increase both for diagnosis and drainage. Recommend PTCD as a temporary treatment measure.