壶腹部癌合并急性胆管炎的治疗选择  

Selection of treatment for periampullary carcinoma complicated with acute cholangitis

作　　者：胡国华[1] 郑烈伟[1] 张轶斌[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国普通外科杂志》2004年第10期764-766,共3页China Journal of General Surgery

摘　　要：目的　探讨壶腹部癌合并急性胆管炎的治疗方法。方法　对比分析 12年间收治的壶腹部癌合并急性胆管炎的临床资料。其中采用一期切除手术 2 5例 ,先作胆道引流二期行切除手术 12例。结果　一期手术组通过非手术治疗 ,术前的体温和白细胞均比入院时明显降低 (P <0 .0 5 ) ,基本达到二期手术组二期切除的术前水平 ( P >0 .0 5 ) ,而总胆红素和清蛋白水平无明显变化 ;与二期组比较 ,一期组切除术前准备期明显缩短 (P <0 .0 5 ) ,手术时间和术中出血量减少 ,虽然术后感染性并发症发生率和术后住院天数增加 ,但再手术率和手术死亡率相似。结论　壶腹部癌合并急性胆管炎可先给予非手术治疗 。Objective To evaluate the therapeutic approach for patients with periampullary carcinoma (complicated) with acute cholangitis. Methods A comparative analysis of the clinical data of cases of (periampullary) carcinoma with acute cholangitis who were admitted and treated in our hospital during a 12-year period.They included 25 cases who underwent primary resection, and 12 cases who underwent a two-stage resection with initial bile duct drainge. Results After conservative procedures, the preoperative temperature and WBC of patients in primary resection group were much lower than when admitted(P<0.05), and were similar to the preoperative level of the two-stage resection group at the time of the second stage resection(P>0.05). Total bilirubin and albumin levels showed no significant changes. Compared with the two-stage resection group,the primary resection group had shorter preoperative preparation time, shorter operation time, lesser intra-operative blood loss, but higher postoperative infection complication rate and prolonged length of hospital stay(P<0.05). There were no statistical differences in reoperation rate and mortality rate between the two groups(P>0.05). Conclusions Patients with periampullary carcinoma complicated with acute cholangitis can initially be treated conservatively . After biliary infection is controlled, primary (pancreatoduodenectomy) is performed.

关 键 词：壶腹部肿瘤/并发症 胆管炎/并发症 急性病 

分 类 号：R735.9[医药卫生—肿瘤] R575.7[医药卫生—临床医学]