急性重症胆管炎54例外科治疗体会  

Surgical Treatment of 54 Patients with Severe Acute Cholangitis( SAC)

作　　者：尹佳欢 王利[1] 吴磊[1] 

机构地区：[1]上海市宝山区罗店医院普通外科,上海201908

出　　处：《临床误诊误治》2015年第3期64-67,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨急性重症胆管炎(ACST)的手术时机和手术原则。方法对我院2010年1月—2013年12月收治的54例ACST的病例资料进行回顾性分析。结果 54例ACST中,24例行经皮经肝胆管引流术(PTCD)或十二指肠镜下乳头括约肌切开术(EST)加鼻胆管引流(ENBD)、胆管内支架置入,急性症状均缓解,其中21例再择期行开腹或腹腔镜胆总管探查取石术;29例行开腹胆总管切开减压+T管引流术;1例行胆总管空肠Roux-en-Y吻合术。本组治愈或好转50例(92.6%),死亡4例(7.4%)。结论急性重症胆管炎早期首选PTCD或EST加ENBD解除胆管梗阻,失败或无效者则选择开腹胆管切开减压+T管引流术,能显著降低病死率。Objective To explore the surgical opportuntiy and principle in treatment of patients with severe acute cholangitis. Methods Clinical data of 54 patients with ACST admitted to our hospital during January 2010 and December 2013 was retrospectively analyzed. Results 24 of the 54 SAC patients were treated with percutaneous transhepatic cholangial drainage （PTCD）, endoscopic sphincterotomy （EST） plus endoscopic nasobiliary drainage （ENBD） or bile duct in racks. Their acute symptoms were then relieved, 21 of the 24 patients were able to receive time selecting open or laparoscopic com-mon bile duct exploration nephrolithotomy; Besides, there were 29 cases among the 54 SAC patients who underwent common bile duct incision decompression with T tube drainage and 1 patient underwent bile duct jejunum Roux-en-Y anastomosis. Fi-nally, 50 cases （92. 6% ） were cured or improved, and 4 patients died （7. 4% ）. Conclusion To drain bile and decrease the expression of bile duct, PTCD or EST plus ENBD are the first choice in the treatment of SAC. If patients can not benefit from the treatment, common bile duct incision decompression with T tube drainage can significantly reduce the fatality rate.

关 键 词：急性重症胆管炎 经皮经肝胆管引流术 经内镜十二指肠乳头括约肌切开术 内镜下鼻胆管引流 

分 类 号：R657.4[医药卫生—外科学]