肝内梗阻型重症胆管炎256例诊疗剖析.docVIP

肝内梗阻型重症胆管炎256例诊疗剖析 　　[摘要] 目的：探讨肝内梗阻型急性化脓性胆管炎的诊治要点及其病理特点。方法：回顾性分析1986～2006年收治的256例肝内梗阻型重症急性胆管炎患者的临床资料。结果：208例行急诊手术，32例经保守治疗缓解后行择期手术，16例经PTCD治疗缓解后行择期手术，术后16例死亡，其余均解除梗阻，通畅引流。结论：对肝内梗阻型急性化脓性胆管炎的诊断，不能追求所谓典型症状。在及时手术引流肝胆总管的同时，应强调对肝脏的探查，慎防遗漏肝内病灶。 　　[关键词] 急性化脓性胆管炎；结石；梗阻；肝脓肿；误诊 　　[中图分类号] R575.7 [文献标识码]A[文章编号]1674-4721（2011）07（a）-050-02 　　 　　Intrahepatic bile duct obstruction diagnosis and treatment of 256 patients with severe cholangitis 　　HU Leshu1, LIU Baichun1, TIAN Haiqing1, LIAO Guoqing2 　　1.Department of Hepatobiliary Surgery, the Central People′s Hospital ofYiyang City, Hunan Province, Yiyang 413000, China; 2. Department of Gastrointestinal Surgery, Xiangya Hospital Central-South University, Hunan Province, Changsha 410008, China 　　[Abstract] Objective: To investigate the intrahepatic bile duct obstruction diagnosis and treatment of acute suppurative cholangitis and its pathological characteristics of elements. Methods: Retrospective analyzed of 1986 to 2006 years, 256 cases were admitted with severe acute cholangitis of intrahepatic bile duct obstruction in patients with clinical data. Results: 208 routine emergency surgery, 32 patients underwent conservative treatment, elective surgery remission, 16 patients underwent remission after PTCD elective surgery, 16 patients died after surgery, the rest were to remove the obstruction, unobstructed drainage. Conclusion: The intrahepatic bile duct obstruction diagnosis of acute suppurative cholangitis, not the pursuit of the so-called typical symptoms. Explorer hepatobiliary surgical drainage in a timely manner, it should also put great emphasis on the exploration of the liver, beware of missing liver lesions. 　　[Key words] Acute suppurative cholangitis; Stone; Obstructive; Liver abscess; Misdiagnosis 　　 　　肝内梗阻型急性重症化脓性胆管炎具有起病急、病情重、并发症多、病死率高的特点，由于其梗阻部位较高，临床表现不典型，极易造成误诊[1-2]。1986年1月～2006年12月，本院共收治肝内梗阻型重症胆管炎256例，现报道如下： 　　1 资料与方法 　　1.1 一般资料 　　本组256例，男156例，女100例，年龄17～72岁，平均62岁；其中，20例以感染性休克急诊入院，其余患者均以持续右上腹部疼痛或肝区叩触痛就诊入