重症急性胆管炎(ACST)96例的救治  

Treatment of the 96 Cases ACST

作　　者：岳茂兴[1] 李学彪[1] 李成林[1] 

机构地区：[1]中国人民解放军第306医院腹部外科中心,北京100101

出　　处：《伤残医学杂志》2004年第2期19-21,共3页Medical Journal of Trauma and Disability

基　　金：解放军总装备部卫生局重点指令性攻关课题No.200010306.

摘　　要：目的:本文探讨手术救治由胆石症导致的重症急性胆管炎(ACST)的经验体会.方法:本组男51例,女45例.行胆总管切开取石、T管引流术、胆囊切除术73例,行胆囊造瘘术,T管引流术13例,行胆肠吻合术3例,行胆总管、空肠Rou—Y吻合术6例,行胆总管囊肿切除、结石取出、肝总管残端与空肠Roux-Y吻合术1例.其中近4年来并发MOF的22例患者采用了“四大一支持”综合疗法.结果:本组96例均行手术治疗,重症急性胆管炎并发多器官功能衰竭22例,占22.91％,死亡9例。总死亡率为9.61％.结论:重症急性胆管炎早期进行手术减压是降低死亡率非常重要的措施之一.当并发MOF时要给予强有力的“四大一支持”综合疗法.即短程大剂量山莨菪碱;短程大剂量地塞米松;大剂量应用抗厌氧菌和抗需氧茵抗生素联合正确应用;腹腔灌洗液清洗腹腔;一支持即完全的代谢营养支持.该疗法有助于ACST病人渡过手术关,在致死性的触发病因去除后,促进器官功能发生逆转最终使患者获得痊愈.Objective: To summarize the experience of the surgical treatment of 96 cases ACST. Methods: 73 cases were undergone exploratory choledocholithotomy, T-type drainage implantation and cholecystectomy. 13 cases were performed cholecystostomy and T-type drainage implantation. 3 cases were performed Roux-en-Y choledochojejunostomy. One case was performed choledochol cyst excision and choledochocystojejunostomy. Si-Da-Yi-Zhichi, a newly treatment of the of multiple organ failure, was applied to the 22 cases ACST. Results: There were 96 cases ACST undergone operation in our study, 22 cases were complicated with multiple organ dysfunction syndrome (22.91%), and 8 cases died from it Total mortality is 9.61%. Conclusion: To reduce the mortality, it was important to give a proper exploration in the early stage of the ACST. Si-Da-Yi-Zhichi might be a newly effective treatment of the MODS. Si-Da-Yi-Zhichi means high dosage administration of anisodamine, dexamethasone and antibiotics in the early stage of the MODS, and thoroughly peritoneal lavage together with metabolism support. Si-Da-Yi-Zhichi could ameliorate the general conditions of the patient and to achieve a safe perioperative stage. Si-Da-Yi-Zhichi could reduce the perioperative mortality of the ACST significantly.

关 键 词：急性胆管炎 ACST 多器官功能衰竭 胆道 营养支持 

分 类 号：R575.7[医药卫生—消化系统]