有胆道手术史老年重症胆管炎67例诊治的的体会.docVIP

有胆道手术史老年重症胆管炎67例诊治的的体会 　　[摘要] 目的： 分析老年人有胆道结石手术史再发结石致重症胆管炎（ACST）的术前处理、手术时机及手术方式，以提高治愈率和降低死亡率。方法：回顾分析本院收治67例有胆道手术史的老年重症胆管炎患者资料。结果：本组67例，治愈出院56例，死亡11例，占16%。结论：术前经皮肝穿胆道引流术（PTCD）减压并充分抗休克后，再手术解除梗阻是提高治愈率降低死亡率的重要方法。 　　[关键词] 经皮肝穿胆道引流术；胆道手术史；老年重症胆管炎；术前准备；手术时机；手术方式 　　[中图分类号] R657.4 [文献标识码] B [文章编号] 1674-4721（2012）01（a）-177-02 　　 　　The experience of diagnosis with biliary surgeries older intensive cholangitis in 67 cases 　　WEI Dekang, QIN Qiang, LING Weiming 　　The Surgical Department of People′s Hospital in Hechi City, Guangxi Zhuang Autonomous Region, Hechi 547000, China 　　[Abstract] Objective: To analyze the preoperative treatment, the operation time and operation method of acute cholangitis of severe type (ACST) in old patients with biliary calculi surgeries, in order to increase the cure rate and reduce mortality. Methods: Clinical data of sixty-seven cases of severe cholangitis patients with biliary surgeries in our hospital were analyzed. Results: In the 67 cases, 56 cases were cured and discharged, 11 cases were dead, accounting for 16%. Conclusion: Preoperative percutaneous liver biopsy biliary drainage technique (PTCD) reduced pressure and fully resistance to shock and then remove obstruction is an important method to improve recovery rate and reduce mortality rate. 　　[Key words] Percutaneous transhepatic baliary drainage; Biliary surgeries; Older intensive cholangitis; Preoperative preparation; Operation time; Operation method 　　 　　本院于2005年8月～2011年8月收治67例有胆道结石手术史再发结石致重症胆管炎的老年患者，先行PTCP后手术，死亡率有所降低，现总结如下： 　　1 资料与方法 　　1.1 一般资料 　　本组67例患者，均有胆道结石手术史，男30例，女37例。年龄56～81岁，平均68岁，经B超、CT证实有肝内外胆管结石并扩张。所有病例均有不同程度的右上腹或剑突下疼痛，巩膜黄染。体温＞39℃ 43例，体温＜36℃ 7例，腹膜炎体征46例，中毒性休克48例，精神异常10例。血常规检查WBC＞20×109/L 37例，合并内科疾病56例，其中，高血压病20例，糖尿病15例，肝、肾功能不全27例，水电解质的碱平衡紊乱49例。 　　1.2 治疗方法 　　本组67例患者均入院即行B超、CT检查明确诊断后，立即禁食、吸氧、补液、抗炎、纠正电解质及酸碱紊乱、药物抗休克治疗同时急诊经皮肝穿引流。在大型C臂机X线透视结合超声引导下穿刺，穿刺成功后，先留取胆汁培养，然后尽量将胆管内淤积胆汁抽空，并用抗生素冲洗胆道，最后在导丝引导下将留有多个侧孔的引流管头端置到十二指肠，另一端体外接引流袋。休克明显改善，电解质紊乱和酸碱失衡纠正后，把握最佳手术时机，行胆总管探查。若引流不畅，或