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目的探讨重症急性胆管炎(ACST)病人的手术时机、原则及影响其预后的因素。方法回顾性总结分析我院68例手术治疗ACST病例资料,手术原则均为胆道减压,胆汁引流。并通过Cox′s比例风险模型对影响预后的因素进行分析。结果68例中合并中毒性休克32例,入院6 h内手术56例,死亡1例,6 h后手术12例,死亡4例。结论ACST起病急、病情重,在出现五联征之前手术,对已有休克的病人给予地塞米松,病情趋稳定不失时机地早期手术治疗;高龄、基础疾病、休克难纠正、合并多器官功能不全是影响预后的主要因素。
Objective To investigate the timing, principle and prognostic factors of patients with severe acute cholangitis (ACST). Methods retrospectively analyzed 68 cases of surgical treatment of ACST in our hospital data, surgical principles are biliary decompression, biliary drainage. The factors influencing the prognosis were analyzed by Cox’s proportional hazards model. Results In 68 cases, 32 cases were complicated with toxic shock, 56 cases were operated within 6 hours after admission, 1 case died, 6 cases were operated after 6 hours and 4 cases died. Conclusions ACST is acute and has serious illness. Before surgery, patients with already existing shock were treated with dexamethasone, and the disease tended to stabilize. Early surgery was the most effective method. Elderly patients, underlying diseases, difficult to correct shock and multiple organ function Incomplete is the main factor affecting the prognosis.