重症急性胆管炎的手术治疗探讨

目的探讨外科手术在治疗重症急性胆管炎的作用。方法手术治疗重症急性胆管炎患者155例(手术组)。手术方式胆总管、肝总管切开取石、取虫,T管引流术145例;胆管空肠Roux-en-Y吻合口切开3例;胆管十二指肠吻合口切开2例;胆管十二指肠吻合3例;单纯胆囊造瘘2例。另外对73例重症急性胆管炎患者采用保守治疗(非手术组)。结果手术组死亡17例,病死率为10.97%,治愈111例,治愈率71.61%,好转27例,好转率17.42%。非手术组死亡28例,病死率为38.36%,治愈3例,治愈率4.11%,好转42例,好转率57.53%。手术组的病死率及治愈率与非手术组相比差异均有非常显著性意义(P<0.001)。结论对于重症急性胆管炎患者应尽早手术引流,同时手术应简单有效。

Operative treatment for severe type acute cholangitis

Objective:To study the significance of surgical operation for severe type acute cholangitis (ACST). Methods:155 patients with ACST were treated with operation from 1996 to 2005 (operation group), including 145 cases treated with calculus and worm removed by incision in common bile duct and common hepatic duct, T tube drainage; 3 with Roux-en-Y anastomotic stoma incision in bile duct and jejunum; 2 with anastomotic stoma incision in bile duct and duodenum; 3 with anastomose in bile duct and duodenum; 2 with pure fistula-making. 73 patients of ACST were treated conservatively as control (non-operation group). Results:In operation group, 17 cases (10.97%) were dead, 111(71.61%) cured, and 27(17.42%) improved. In non-operation group, 28 cases (38.36%) were dead, 3(4.11%) cured, and 42(57.53%) improved. The death rate and cure rate in the operation group were significantly different to those in the non-operation group (P<0.001). Conclusion:The patients of ACST should be operated to drainage as soon as possible.It is simple and effective method for ACST.