恶性胆汁淤积性黄疸合并急性胆管炎手术预后的影响因素  

Prognostic Factors of Operation for Malignant Obstructive Jaundice Combined with Acute Cholangitis

作　　者：戚鹏 王强[1] 殷奇 武海涛 刘阳 

机构地区：[1]武汉科技大学医学院,湖北武汉430065 [2]湖北省第三人民医院普外科,湖北武汉430030

出　　处：《医学新知》2017年第5期466-468,共3页New Medicine

摘　　要：目的 探索恶性梗阻性黄疸合并急性胆管炎手术预后的影响因素.方法 回顾性分析186例恶性梗阻性黄疸手术的临床资料.将合并有急性胆管炎的恶性梗阻性黄疸手术患者作为观察组（39例）,将未合并有急性胆管炎的恶性梗阻性黄疸患者作为对照组（147例）.比较两组手术并发症率及手术死亡率及ALT,AST,BUN,CR,TP,ALB,WBC,CRP,IL-6,TNF-α,降钙素原等.结果 两组一般资料无显著性差异,具有可比性.观察组有明显升高的手术并发症率及死亡率,ALT,AST,BUN,CR,TP,ALB,WBC,CRP,IL-6,TNF-α,降钙素原均明显高于对照组.结论 急性胆管炎会造成不良手术预后,其机制可能是急性胆管炎引起全身及局部炎症反应,导致多器官功能不全所致.对恶性胆汁淤积性黄疸合并有急性胆管炎,应在术前尽可能控制感染,而非手术治疗.Objective To explore prognostic factors of operation for malignant obstructive jaundice combined with acute cholangitis. Methods Clinical data of 186 patients with malignant obstructive jaundice were retrospectively analyzed. Patients with malignant obstructive jaundice combined with acute cholangitis were enrolled to observation group（ n =39）. Patients with only malignant obstructive jaundice were enrolled to control group（ n = 147 ）. Complica- tion rate, mortality rate, ALT, AST, BUN, CR, TP, ALB, WBC, CRP, IL - 6, TNF - ct and procalcitonin were compared between the two groups. Results Complication rate and mortality rate were significantly higher in observation group than those in control group. ALT, AST, BUN, CR, TP, ALB, WBC, CRP, IL - 6, TNF - ct and procalcitonin were signifi- cantly higher in observation group than those in control group. Conclusion Acute cholangitis can result in poor prog- nosis. Its mechanism may be that acute cholangitis leads to local and systemic inflammatory response, which can finally result in multiple organ dysfunction. Controlling infection as quickly as possible is the key for malignant obstructive jaundice combined with acute cholangitis rather than surgery.

关 键 词：胆管炎 梗阻性黄疸 预后 因素分析 

分 类 号：R446.5[医药卫生—诊断学]