损伤控制在急性胆管炎治疗中的应用  

The application of the technique of damage control in treatment of acute cholangitis

作　　者：吴钢[1] 殷保兵[1] 陈进宏[1] 马保金[1] 蔡端[1] 

机构地区：[1]复旦大学附属华山医院外科,上海200040

出　　处：《肝胆胰外科杂志》2006年第4期208-210,共3页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金资助项目(30070737)

摘　　要：目的探讨损伤控制在急性胆管炎患者治疗中的应用。对急性胆管炎的早期复苏、手术时机及手术方法、鼻胆管引流的指征、细菌培养和减少围手术期并发症的重要性进行讨论。方法回顾分析1995年1月至2005年12月收治的急性胆管炎非保守治疗患者88例,其中手术治疗72例,经十二指肠镜鼻胆管引流术(ENBD)15例和B超引导下经皮经肝胆囊穿刺引流(PTGD)1例。并对术中胆汁细菌学培养和抗生素治疗等情况进行总结分析。结果术后死亡5例,胆道残余结石9例,29例出现并发症。ENBD治疗15例,均一期治愈。术中胆汁细菌学培养60例,39例培养阳性,培养出细菌51株。结论急性胆管炎患者诊断一旦明确,在创伤控制理论的指导下,尽早进行复苏,抗感染,纠正休克、水电解质及酸碱平衡紊乱和凝血功能异常。首要目的在于抢救患者生命,治疗及手术力求简单有效。ENBD创伤小,胆道减压效果确实,亦为择期手术创造了条件。胆汁细菌学培养和药敏试验应列为常规,对调整抗生素用药有指导意义。Objective To explore the application of the technique of damage control in treatment of acute cholangitis and discuss the importance of the indication of endoscopic nasobiliary drainage （ENBD） and antibiotic therapy in patients with acute cholangitis, as well as resuscitation and the measures to reduce the perioperative complications. Methods Retrospective analysis was made on the result of treatment（operation,ENBD,PTGD and antibiotic therapy） and pathogenic becterla isolated from bile. This 88 cases of acute cholangitis were inpatients of our hospital from Jan 1995 to Dec 2005,open operations were done on 72 cases,ENBD 15 patients and PTGD 1 case. Results 72 patients received emergency operations and 5 died. 29 complications occurred and 9 residual stone; 15 cases were cured by ENBD and 1 case by PTGD; 51 strains of pathogenic becteria were isolated from bile. Conclusion Simple and effective emergency operation is necessary for acute cholangitis patients. Shock, disorder of fluid ＆ electrolyte and acid-base balance should be corrected. ENBD is a minimal invasive procedure and its effect of drainage is reliable, also is suitable as preoperative preparation for seletive operation. Bacterial culture and drug sensitivity test should be performed routinely, the results of which carry an important guiding factor for choosing appropriate antimicrobial agents.

关 键 词：急性胆管炎 损伤控制 手术治疗 鼻胆管引流术 

分 类 号：R657.45[医药卫生—外科学]