重症胆管炎的诊断与治疗

王荣峰; 吕毅; 张晓刚

doi:10.3969/j.issn.1001-5256.2019.12.002

重症胆管炎的诊断与治疗

DOI: 10.3969/j.issn.1001-5256.2019.12.002

西安交通大学第一附属医院肝胆外科

详细信息

中图分类号: R657.45
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出版历程
- 收稿日期: 2019-10-29
- 出版日期: 2019-12-20

Advances in the diagnosis and treatment of severe acute cholangitis

Department of Hepatobiliary Surgery,The First Affiliated Hospital of Xi'an Jiaotong University

摘要

摘要: 重症胆管炎又称急性梗阻性化脓性胆管炎,起病急,病情发展迅速,是良性胆道疾病的首要死亡因素(尤其在高龄患者中),常伴有多系统器官功能衰竭的情况。其症状及体征多样化,诊断分级及预后标准常不一致。随着外科微创及内镜技术发展,重症胆管炎的诊治效果得到不断改善。如何根据预后因素评判、选择最佳手术时机,个体化选择胆道引流方式,全面、规范、及时抗感染治疗,在重症胆管炎的治疗中具有非常重要的意义。
- 胆管炎 /
- 诊断 /
- 抗菌药 /
- 引流术 /
- 治疗学
Abstract: Severe acute cholangitis,also called acute obstructive suppurative cholangitis( AOSC),has acute onset and rapid progression and is the primary cause of death in patients with benign biliary tract diseases,especially in elderly patients,and it is often complicated by multiple system organ failure. This disease has diversified symptoms and signs,which leads to the inconsistency in diagnostic grading and prognosis criteria. With the development of minimally invasive surgery and endoscopic techniques,the diagnosis and treatment of severe acute cholangitis has been constantly improved. Therefore,judgment and selection of the optimal surgical timing,individualized biliary drainage,and comprehensive,standardized,and timely anti-infective therapy based on prognostic factors have great importance in the treatment of severe acute cholangitis.
- cholangitis /
- diagnosis /
- anti-bacterial agents /
- drainage /
- therapeutics

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参考文献(50)

[1] MA CL,WANG LP,QIAO S,et al. Risk factors for death of elderly patients with acute obstructive suppurative cholangitis[J]. West Indian Med J,2015,65(2):316-319.

[2] ZHANG X,LI G,PAN L,et al. The efficacy and safety of one-stage endoscopic treatment for ascending acute cholangitis caused by choledocholithiasis with severe comorbidities[J].Surg Endosc,2019.[Epub ahead of print]

[3] KIRIYAMA S,TAKADA T,HWANG TL,et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis:An international multicenter observational study[J]. J Hepatobiliary Pancreat Sci,2017,24(6):329-337.

[4] KIRIYAMA S,KOZAKA K,TAKADA T,et al. Tokyo Guidelines2018:Diagnostic criteria and severity grading of acute cholangitis(with videos)[J]. J Hepatobiliary Pancreat Sci,2018,25(1):17-30.

[5] KARKI S,JOSHI KS,REGMI S,et al. Role of ultrasound as compared with ERCP in patient with obstructive jaundice[J].Kathmandu Univ Med J(KUMJ),2013,11(43):237-240.

[6] PATEL NB,OTO A,THOMAS S. Multidetector CT of emergent biliary pathologic conditions[J]. Radiographics,2013,33(7):1867-1888.

[7] LIU F,CHEN ZH,FANG ZW,et al. Value of the tense gallbladder wall sign on MDCT in the diagnosis of acute cholecystitis[J]. Diagn Imag Interv Radiol,2018,27(6):445-450.(in Chinese)刘锋，陈壮浩，方字文，等．MSCT胆囊触壁征对判定急性期胆囊炎的价值[J]．影像诊断与介入放射学，2018,27(6):445-450.

[8] SINGH A,MANN HS,THUKRAL CL,et al. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice[J]. J Clin Diagn Res,2014,8(3):103-107.

[9] ARAI K,KAWAI K,KOHDA W,et al. Dynamic CT of acute cholangitis:Early inhomogeneous enhancement of the liver[J]. AJR Am J Roentgenol,2003,181(1):115-118.

[10] YAO BY,HUANG ZM. Changes of HDL-C,ALB and WBC in patients with acute cholangitis before and after ERCP[J].Zhejiang J Traumatic Surg,2019,24(4):735-737.(in Chinese)姚必瑜，黄智铭．急性胆管炎ERCP术前术后HDL-C及Alb、WBC的变化研究[J]．浙江创伤外科，2019,24(4):735-737.

[11] CUI DY,LIN YF,WANG CH,et al. Discussion on the opportunity of endoscopic treatment of acute obstructive suppurative cholangitis[J]. Chin J Integr Trad West Med Dig,2014,22(10):611-612.(in Chinese)崔丹阳，林一帆，王长洪，等．急性梗阻性化脓性胆管炎内镜治疗时机的分析讨论[J]．中国中西医结合消化杂志，2014,22(10):611-612.

[12] YUAN QG. Early surgical intervention on the prognosis of severe acute cholangitis[J]. J Hunan Normal Univ(Med Sci),2016,13(5):31-33.(in Chinese)袁庆功．早期手术干预对急性重症胆管炎预后的影响[J]．湖南师范大学学报(医学版)，2016,13(5):31-33.

[13] GALLAGHER EJ,ESSES D,LEE C,et al. Randomized clinical trial of morphine in acute abdominal pain[J]. Ann Emerg Med,2006,48(2):150-160.

[14] TSUYUGUCHI T,SUGIYAMA H,SAKAI Y,et al. Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines[J]. J Hepatobiliary Pancreat Sci,2012,19(5):557-565.

[15] HAKUTA R,HAMADA T,NAKAI Y,et al. No association of timing of endoscopic biliary drainage with clinical outcomes in patients with non-severe acute cholangitis[J]. Dig Dis Sci,2018,63(7):1937-1945.

[16] SUETANI K,OKUSE C,NAKAHARA K,et al. Thrombomodulin in the management of acute cholangitis-induced disseminated intravascular coagulation[J]. World J Gastroenterol,2015,21(2):533-540.

[17] OKUDA A,OGURA T,IMANISHI M,et al. Clinical impact of recombinant soluble thrombomodulin for disseminated intravascular coagulation associated with severe acute cholangitis[J]. Gut Liver,2018,12(4):471-477.

[18] YUAN MJ,YUAN WQ,CHEN LZ,et al. Application of multidisciplinary collaborative diagnosis and treatment mode in the management of critical patients in general surgery[J/CD].Chin J Critical Care Med(Electronic Edition),2019,12(1):63-66.(in Chinese)袁美娟，袁文琴，陈灵芝，等．多学科协作诊疗模式在普外科危重患者管理中的应用研究[J/CD]．中华危重症医学杂志(电子版)，2019,12(1):63-66.

[19] RHODES A,EVANS LE,ALHAZZANI W,et al. Surviving sepsis campaign:International guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304-377.

[20] GAO QB,LI WG,LIN MQ,et al. Efficacy of endoscopic retrograde cholangiopancreatography for the treatment of patients with acute obstructive suppurative cholangitis[J]. J Prac Hepatol,2019,22(5):740-743.(in Chinese)高青豹，李文刚，林明强，等．经内镜下逆行胰胆管造影术治疗急性梗阻性化脓性胆管炎患者疗效及感染病原菌调查[J]．实用肝脏病杂志，2019,22(5):740-743.

[21] YANG Q,WANG H,CHEN M,et al. Surveillance of antimicrobial susceptibility of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in China:The 2002-2009 Study for Monitoring Antimicrobial Resistance Trends(SMART)[J]. Int J Antimicrob Agents,2010,36(6):507-512.

[22] van DULM E,THOLEN A,PETTERSSON A,et al. High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam,the Netherlands[J]. PLo S One,2019,14(9):e0222200.

[23] GOMI H,TAKADA T,HWANG TL,et al. Updated comprehensive epidemiology,microbiology,and outcomes among patients with acute cholangitis[J]. J Hepatobiliary Pancreat Sci,2017,24(6):310-318.

[24] SUNG YK,LEE JK,LEE KH,et al. The clinical epidemiology and outcomes of bacteremic biliary tract infections caused by antimicrobial-resistant pathogens[J]. Am J Gastroenterol,2012,107(3):473-483.

[25] SALVADOR VB,LOZADA MC,CONSUNJI RJ. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center[J]. Surg Infect(Larchmt),2011,12(2):105-111.

[26] REUKEN PA,TORRES D,BAIER M,et al. Correction:Risk factors for multi-drug resistant pathogens and failure of empiric first-line therapy in acute cholangitis[J]. PLo S One,2017,12(2):e0172373.

[27] RHODES A,EVANS LE,ALHAZZANI W,et al. Surviving sepsis campaign:International guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304-377.

[28] SOLOMKIN JS,MAZUSKI JE,BRADLEY JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children:Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America[J]. Surg Infect(Larchmt),2010,11(1):79-109.

[29] SOLOMKIN JS,MAZUSKI JE,BRADLEY JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children:Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America[J]. Clin Infect Dis,2010,50(2):133-164.

[30] GOMI H,TAKADA T,HWANG TL,et al. Updated comprehensive epidemiology,microbiology,and outcomes among patients with acute cholangitis[J]. J Hepatobiliary Pancreat Sci,2017,24(6):310-318.

[31] KUMARASAMY KK,TOLEMAN MA,WALSH TR,et al. Emergence of a new antibiotic resistance mechanism in India,Pakistan,and the UK:A molecular,biological,and epidemiological study[J]. Lancet Infect Dis,2010,10(9):597-602.

[32] SCHULTSZ C,GEERLINGS S. Plasmid-mediated resistance in enterobacteriaceae:Changing landscape and implications for therapy[J]. Drugs,2012,72(1):1-16.

[33] SAWAS T,ARWANI N,AL HALABI S,et al. Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis:A meta-analysis[J]. Endosc Int Open,2017,5(2):e103-e109.

[34] UMEFUNE G,KOGURE H,HAMADA T,et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis:A single-center prospective study[J]. J Gastroenterol,2017,52(6):734-745.

[35] SAAD WE,WALLACE MJ,WOJAK JC,et al. Quality improvement guidelines for percutaneous transhepatic cholangiography,biliary drainage,and percutaneous cholecystostomy[J].J Vasc Interv Radiol,2010,21(6):789-795.

[36] GUO J,SUN S,LIU X,et al. Endoscopic ultrasound-guided biliary drainage using a fully covered metallic stent after failed endoscopic retrograde cholangiopancreatography[J]. Gastroenterol Res Pract,2016,2016:9469472.

[37] MINAGA K,KITANO M,IMAI H,et al. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis[J]. World J Gastroenterol,2016,22(16):4264-4269.

[38] LEE TH,CHOI JH,PARK DO H,et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction[J]. Clin Gastroenterol Hepatol,2016,14(7):1011-1019. e3.

[39] SHARAIHA RZ,KHAN MA,KAMAL F,et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails:A systematic review and meta-analysis[J]. Gastrointest Endosc,2017,85(5):904-914.

[40] OTANI K,UEKI T,MATSUMURA K,et al. Comparison between endoscopic biliary stenting and nasobiliary drainage in patients with acute cholangitis due to choledocholithiasis:Is endoscopic biliary stenting useful?[J]. Hepatogastroenterology,2015,62(139):558-563.

[41] ZHANG RL,CHENG L,CAI XB,et al. Comparison of the safety and effectiveness of endoscopic biliary decompression by nasobiliary catheter and plastic stent placement in acute obstructive cholangitis[J]. Swiss Med Wkly,2013,143:w13823.

[42] GOMI H,OKAMOTO K,UKAI T,et al. Response to Re:Tokyo Guidelines 2018:Antimicrobial therapy for acute cholangitis and cholecystitis[J]. J Hepatobiliary Pancreat Sci,2018,25(6):e6.

[43] KAWAKUBO K,KAWAKAMI H,KUWATANI M,et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma[J]. World J Gastrointest Endosc,2016,8(9):385-390.

[44] ZHENG M,LIU X,LI N,et al. Emergency endoscopic needle-knife precut papillotomy in acute severe cholangitis resulting from impacted common bile duct stones at duodenal papilla[J]. Dig Liver Dis,2018,50(3):267-270.

[45] WANG HG,WANG Y,GUO QM,et al. Retrograde cholangiopancreatography and laser lithotripsy for choledocholithiasis in126 elderly patients with acute obstructive suppurative cholangitis[J]. China J Endosc,2016,22(1):106-108.(in Chinese)王宏光，王莹，郭庆梅，等．逆行性胰胆管造影胆总管巨大结石激光碎石术治疗老年急性梗阻化脓性胆管炎126例[J]．中国内镜杂志，2016,22(1):106-108.

[46] HUI CK,LAI KC,YUEN MF,et al. Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis?[J]. Gastrointest Endosc,2003,58(4):500-504.

[47] TRINDADE AJ,MELLA JM,SLATTERY E,et al. Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography[J]. Endoscopy,2015,47(5):453-456.

[48] ISHII K,ITOI T,TONOZUKA R,et al. Balloon enteroscopyassisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae(with videos)[J]. Gastrointest Endosc,2016,83(2):377-386. e6.

[49] PIZZICANNELLA M,CAILLOL F,PESENTI C,et al. EUS-guided biliary drainage for the management of benign biliary strictures in patients with altered anatomy:A single-center experience[J].Endosc Ultrasound,2019.[Epub ahead of print]

[50] LEE YN,MOON JH,CHOI HJ,et al. Direct biliary drainage using transnasal endoscopy for patients with severe-to-moderate acute cholangitis[J]. J Gastroenterol Hepatol,2013,28(4):739-743.

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