CAJ | 학술논문

目的：评价《东京指南》指导急性胆管炎诊治的临床意义。方法回顾性分析2006年10月至2012年10月，按照《东京指南》推荐的诊断和病情评估标准、治疗策略，我院共收治的223例患者的临床资料。结果（1）根据 Charcot's 三联征的诊断标准，只有64.1%（143/223）可以首次确诊，但依据《东京指南》的诊断标准，首诊率达86.09%（192/223），但误诊了19例（19/242，7.85%）非胆管炎患者；（2）根据《东京指南》病情分级评估标准，轻度（Ⅰ级）约30.49%（68/223），中度（Ⅱ级）约55.6%（124/223），重度（Ⅲ级）约13.9%（31/223），仅仅7.6%（17/223）满足传统诊断重症胆管炎的Reynold's五联征临床标准；（3）胆石症和恶性肿瘤是引起急性胆管炎的主要原因，分别为81.17%（181/223）和10.77%（24/223）。95.96%（214/223）有胆管梗阻，4.14%（9/223）无胆管扩张，但有胆道“积气征”；（4）63.23%（141/223）的患者予以了胆管引流，ENBD、PTCD等引流的有效率为70.45%（62/88）；（5）总的死亡率为5.38%（12/223），58.33%（7/12）因合并有其他系统严重疾病而死亡。结论《东京指南》指导急性胆管炎的诊治，能获得更准确的诊断和疾病严重程度，处理策略规范而实用，可明显降低死亡率，但可能导致“假阳性”的误诊。
목적：평개《동경지남》지도급성담관염진치적림상의의。방법회고성분석2006년10월지2012년10월，안조《동경지남》추천적진단화병정평고표준、치료책략，아원공수치적223례환자적림상자료。결과（1）근거 Charcot's 삼련정적진단표준，지유64.1%（143/223）가이수차학진，단의거《동경지남》적진단표준，수진솔체86.09%（192/223），단오진료19례（19/242，7.85%）비담관염환자；（2）근거《동경지남》병정분급평고표준，경도（Ⅰ급）약30.49%（68/223），중도（Ⅱ급）약55.6%（124/223），중도（Ⅲ급）약13.9%（31/223），부부7.6%（17/223）만족전통진단중증담관염적Reynold's오련정림상표준；（3）담석증화악성종류시인기급성담관염적주요원인，분별위81.17%（181/223）화10.77%（24/223）。95.96%（214/223）유담관경조，4.14%（9/223）무담관확장，단유담도“적기정”；（4）63.23%（141/223）적환자여이료담관인류，ENBD、PTCD등인류적유효솔위70.45%（62/88）；（5）총적사망솔위5.38%（12/223），58.33%（7/12）인합병유기타계통엄중질병이사망。결론《동경지남》지도급성담관염적진치，능획득경준학적진단화질병엄중정도，처리책략규범이실용，가명현강저사망솔，단가능도치“가양성”적오진。
Objective To investigate the clinical significance of Tokyo Guidelines for acute cholangitis(AC). Methods 223 patients involved in the study, following the diagnositic criteria and severity assessment and strategy of treatments, were analyzed retrospectively from Oct. in 2006 to Oct. in 2012 in our hospital. Results (1) Following the traditional criteria of Charcot's trid, only 64.1%(143/223) of AC got definite diagnosis at the first time, whereas that was 86.09%(192/223) following the Tokyo Guidelines criteria, but 7.85%of non-AC were misdiagnosed as AC. (2) To assess the severity of AC suggested by Tokyo Guidelines, there were 30.49%(68/223) of mild (gradeⅠ), 55.6% (124/223) of moderate (grade Ⅱ) and 13.9% (31/223) of severe (grade Ⅲ), while only 7.6%(17/223) satisfied sever AC according to Reynold’s Pentad. (3) choledocholithiasis or malignant tumors were the common etiologies, 81.17%(181/223) or 10.77% (24/223), respectively. 95.96%of patients had biliary obstruction, while other 4.14% (9/223) had not biliary dilatation but "accumulative gas sign". (4) Biliary drainage was performed in 63.23% (141/223) of patients. The effective rate of ENBD and PTCD was about 70.45% (62/88). (5) Total mortality was 5.38% (12/223), and 58.33% (7/12) of death were simultaneously concomitant with serious disease in other organs or systems. Conclusion It is more precise to diagnose and evaluate the severity of AC that employing the criteria of Tokyo Guidelines. Furthermore, the strategy of the treatments is very normative and practical. The mortality can be obviously reduced on account of following the recommendations of Tokyo Guidelines. However, it maybe misdiagnose because of false positive.