急性重症胆管炎122例临床剖析.docVIP

急性重症胆管炎122例临床剖析 　　[摘要] 目的:探讨急性重症胆管炎 (ACST)的早期诊断指标、发生发展规律、影响预后的因素及手术时机的选择。方法:回顾性分析122例ACST患者的临床资料。结果:全组122 例中死亡27 例,病死率为22.13%(27/122)。手术治疗116 例中死亡22例,病死率为18.97% (22/116)。非手术治疗6例中死亡5例。年龄60 岁者病死率为31.58%。发生 MODS24例中死亡16例,病死率为 66.67%(16/24)。发病时间 ≤72 h者病死率为15.29%;发病时间72 h者病死率为37.84%。考虑患者年龄、手术时机的掌握及合并MODS等因素,与 ACST患者的死亡关系显著。结论:充分认识 ACST的危险因素,把握好手术时机,早期手术减压引流胆道,按ACST分级诊断、治疗,是降低 ACST死亡率的有效途径。 　　[关键词] ACST;MODS;诊断;手术 　　[中图分类号] R657.4+5[文献标识码]A[文章编号]1673-7210(2009)07(b)-030-02 　　 　　Clinical analysis of 122 cases of acute cholangitis of severe type 　　LI Li 　　(Department of Liver and Gallbladder Surgery, NanchongMunicipal FifthPeoples Hospital, Sichuan Province, Nanchong637100, China) 　　[Abstract] Objective: To discuss acute cholangitis of severe type (ACST) about its early diagnosis index, rule of occurrence and development, influencing factors of prognosis and choice of operation time. Methods: Analyzing the clinical data of 122 cases of ACST retrospectively. Results: There were 27 patients died in the whole group of 122 cases and the fatality rate was 22.13%(27/122). 22 patients died among 116 patients who had got operation and the fatality rate was 18.97%(22/116). 5 patients died among 6 cases getting non-operative therapy. Among those beyond 60 years old the fatality rate was 31.58%. 16 patients died among those 24 cases with multiple organ dysfunction syndrome(MODS) and the fatality rate was 66.67%(16/24).The fatality rate of those withcourse less than 72 h was 15.29% and those beyond 72 h was 37.84%. So we thought the age, choice of operation time and MODS combination were the influencing factors of mortality of ACST patients. Conclusion: Recognizing the risk factors of ACST thoroughly, choosing proper operation time, decompressing and draining biliary tract early by operation, diagnosing and treating patients according to ACST grading may be the effective methods to reduce the mortality of ACST. 　　[Key words] ACST; MODS; Diagnosis; Operation 　　 　　急性梗阻性化脓性胆管炎