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目的:分析恶性梗阻性黄疸(MOJ)与急性黄疸性肝炎的临床特点,以期减少误诊,提高临床快速诊治水平。方法:根据病史、临床症状、体征、相关的实验室检查、B超、CT、ERCP等影像学检查,对1988年～1998年间因误诊为急性黄疸性肝炎(急肝、AJH)而转入传染病专科医院,最后经确诊为恶性梗阻性黄疸(恶梗黄、MOJ)的145例患者,与同期急性黄疸性肝炎比较。结果:二者相比症状方面除共同具有乏力、恶心、呕吐、尿黄等表现外,MOJ患者多有上腹不适,腹胀、腹痛、皮肤骚痒等症状,体征方面除共同表现为皮肤巩膜黄染外,梗黄患者可伴有消瘦,腹部包块,腹部压痛。化验:恶梗黄患者ALT 218.58±172.78u/L,急肝1032.28±383.21u/L,二者相比P<0.001。总胆红素峰值均数:恶梗黄16.03±10.10mg/dL,急肝7.24±L15mg/dL,二者相比P<0.001,γ—GT:恶梗黄400.15±341.00u/L,急肝67.02±9.51u/L,AKP:恶梗黄333.31±160.79,急肝46.282±3.93。结论:根据病史,体征及肝功能检查等相关化验,结合影像学检查(Bus,EUS,ERCP,PTC,CT)可明确恶性梗阻性黄疸的诊断。
Objective: To analyze the clinical features of malignant obstructive jaundice (MOJ) and acute jaundice hepatitis in order to reduce misdiagnosis and improve the rapid clinical diagnosis and treatment. METHODS: According to medical history, clinical symptoms, signs, related laboratory examinations, B-ultrasonography, CT, ERCP, and other imaging examinations, infections were diagnosed as being misdiagnosed as acute jaundice hepatitis (emergency liver, AJH) between 1988 and 1998. Specialized hospitals, and finally 145 patients with malignant obstructive jaundice (defective jaundice, MOJ) were compared with acute icteric hepatitis in the same period. Results: In addition to the symptoms of the two together have fatigue, nausea, vomiting, urinary yellow and other symptoms, MOJ patients have more abdominal discomfort, abdominal distension, abdominal pain, skin itching and other symptoms, signs in addition to the common performance of the skin yellow sclera In addition to dyeing, patients with yellow stems may be accompanied by weight loss, abdominal mass, and abdominal tenderness. Laboratory tests showed that ALT was 218.58±172.78u/L and acute liver was 1032.28±383.21u/L. The peak mean number of total bilirubin was 16.03±10.10 mg/dL for oxemia yellow, and 7.24±L15 mg/dL for acute liver, which was P<0.001 compared with γ-GT: 400.15±341.00u/L for diarrhea. 67.02±9.51u/L, AKP: evil stalks yellow 333.31±160.79, acute liver 46.282±3.93. Conclusion: The diagnosis of malignant obstructive jaundice can be confirmed by the combination of medical history, physical signs and liver function test, and imaging examinations (Bus, EUS, ERCP, PTC, and CT).