Early diagnosis and treatment of severe acute cholangitis
摘要
AIM: To investigate the diagnostic standard for earlyidentification of severe acute cholangitis in order to lowerthe incidence of morbidity and mortality rate.METHODS: A diagnostic standard was proposed in thisstudy as follows: documented biliary duct obstruction byultrasound or computerized tomography or other imagingtools with the manifestation of systemic inflammatoryresponse syndrome (SIRS). The surgical proceduresincluded emergency common bile duct exploration with Ttube insertion or cholecystostomy with secondary commonbile duct exploration. And incidence of postoperativemultiple organ dysfunction syndrome (MODS), duration ofsystemic inflammatory response and hospital mortality wereanalyzed.RESULTS: Fourty - three patients conforming to thediagnostic standard described above were employed in thisstudy. 1 patient was admitted in acutely ill condition andcomplicated with acute relapse of chronic bronchitis,cholecystostomy procedure was performed but the patientwas complicated with postoperative acute lung injury whiclwas treated by assisted mechanical ventilation for 5 d; 2 wllater, two- stage common bile duct Exploration and T tubeinsertion were performed. The remaining 42 patientsunderwent primary common bile duct exploration and T tubeinsertion, 1 developed acute lung injury and recovered 3 dlater, 2 patients developedl acute renal dysfunction, 1 ofwhich recovered 2 d later and the other died on d 4. For allpatients, the postoperative systemic inflammatory responsepersisted for 2 to 8 d with median of 3 d.CONCLUSION: Early diagnosis of severe acute cholangitiscan be made using this diagnostic standard, furtherdevelopment of systemic inflammatory response could beprevented and incidence of MODS as well as hospitalmortality decreased.