63例急诊胆道梗阻患者临床诊疗分析  

Analysis of clinical diagnosis and treatment in 63 patients with emergency biliary obstruction

作　　者：魏红涛[1] 张天鹏[1] 刘冰[1] 章建东[1] 王国兴[1] Wei Hongtao;Zhang Tianpeng;Liu Bing;Zhang Jiandong;Wang Guoxing(Department of Emergency,Emergency and Critical Care Center of Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院急危重症救治中心急诊科,100050

出　　处：《中国医师杂志》2020年第1期8-11,共4页Journal of Chinese Physician

基　　金：北京市医院管理中心临床医学发展专项——"扬帆"计划(ZYLX201802)。

摘　　要：目的提高对急诊胆道梗阻(BO)疾病的认识,进而提高BO患者的诊治能力。方法回顾性分析2014年9月至2015年2月本院收治的63例BO患者的病因诊断、临床表现、影像学资料、实验室检查和急诊治疗转归。结果胆总管结石是BO患者中最常见的致病原因,占63.49%,其次是胆管癌,占19.05%;BO患者最常见的临床表现为黄疸(90.48%)、腹痛(87.30%)、发热(53.97%);腹部电子计算机断层扫描(CT)和磁共振胰胆管造影(MRCP)对于BO患者的诊断能力明显高于超声,差异有统计学意义(P<0.05),但CT和MRCP的诊断能力比较差异无统计学意义(P=1.000);相较于良性病变组,恶性病变组血红蛋白和白蛋白较低,而总胆红素和直接胆红素较高,差异均有统计学意义(P<0.05);BO患者经过治疗后大多数患者取得好转,BO患者就诊当次死亡率为3.17%(2/63)。结论胆总管结石和胆管癌仍是急诊BO患者最常见的病因;急诊BO患者最常见的临床表现为黄疸、腹痛、发热;在急诊BO患者的诊断方面,CT和MRCP诊断能力相当,均明显优于腹部超声;贫血、高胆红素和低蛋白血症是急诊BO患者恶性肿瘤的报警指标;大多数患者通过急诊诊治后能够暂时获得病情好转。Objective To improve the awareness of emergency biliary obstruction(BO)disease,and to further improve the diagnosis and treatment ability of BO patients.Methods Data of the etiology,clinical manifestations,imaging data,laboratory tests,and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.Results Common bile duct stones were the most common cause of BO patients(63.49%),followed by cholangiocarcinoma(19.05%);the most common clinical manifestations of BO patients were jaundice(90.48%),abdominal pain(87.30%),and fever(53.97%);the diagnostic ability of computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP)in patients with BO was significantly higher than that of ultrasound(P<0.05),but there was no significant difference between CT and MRCP(P=1.000);compared with benign group,hemoglobin and albumin in malignant group were significantly lower,while total bilirubin and direct bilirubin were higher,with statistically significant difference(P<0.05).Most patients in BO patients improved after treatment,and the mortality rate of BO patients was 3.17%(2/63)at the end of emergency visit.Conclusions Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients.The most common clinical manifestations of patients with emergency BO are jaundice,abdominal pain,and fever.Better than abdominal ultrasound,CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients.Anemia,hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients.Most patients can temporarily get better at the end of emergency visit.

关 键 词：胆总管结石病 胆管肿瘤 胆道梗阻 胰胆管造影术 磁共振 急诊处理 胆道外科手术 

分 类 号：R575.7[医药卫生—消化系统]