不同术式治疗急性梗阻性化脓性胆管炎的临床研究

摘要

Objective To discuss the effectivenes of different operation on patients with acute obstructive supputative cholangitis(AOSC). Methods The clinical data of 42 patients with AOSC from January 2005 to December 2010 were collected and analyzed retrospectively. All patients were divided into the emergency surgery group(15 cases)and the surgery by stages group(27 cases ). The emergency surgery group were treated by traditional emergency operation .The surgery by stages group were treated by Endoscopic Retrograde Cholangio Canereatography(ERCP)+Endoscopic Sphincterotomy( EST )+Laparosopy (LC), ERCP +EST+ endoscopic nasobiliary drainage(ENBD)+surgery operation, and percutaneous transhepatie cholangio drainage (PTCD). Results The emergency surgery group ( 15 cases ) were operated by emergency surgery, the surgery by stages group( 27 cases ) were operated by stages. Among 27cases, 19 cases were used ERCP +EST+ ENBD, 10 cases LC among 19 cases.5 cases ERCP +EST+ENBD+operation.3 cases PTCD. Complications of emergency surgery group is more than surgery by stages group. Emergency surgery group and surgery by stages group died each 1 patient. Conclusions Treatment on patients with AOSC would choose simple and effectual operation by stages. Disengaging the obstruction earlier and drainaging enough the biliary tract are the key points in treatment. To select again operative time and complete exhaustiveced operation waiting for patient ferry crises.%目的 探讨不同术式在治疗急性梗阻性化脓性胆管炎的疗效.方法 回顾分析2005年1月至2010年12月42例急性梗阻性化脓性胆管炎患者的临床资料.全部病例分成急诊外科手术组(15例)和分期手术组(27例),急诊外科手术组接受传统外科手术,分期手术组接受ERCP+EST+LC,ERCP+EST+ENBD+外科手术和经皮肝穿刺胆道引流术(PTCD)+外科手术.结果 急诊外科手术组15例均接受传统外科手术.分期手术组27例中,ERCP+EST 19例,其中,二期LC10例;ERCP+EST+ENBD+外科手术5例;经皮肝穿刺胆道引流术(PTCD)+外科手术3例.急诊手术的并发症较分期手术多.急诊手术和分期手术各死亡1例.结论 急性梗阻性化脓性胆管炎的手术治疗宜采用简单、有效的分期手术.早期解除梗阻、充分引流是治疗的关键,待患者渡过危险期后,再择期手术,完成彻底的治疗.