CAJ | 학술논문

目的：探讨胆道结石并胆道感染的临床分型及手术时机。方法从2011年5月至2013年5月收治的胆道结石并胆道感染患者中随机选择100例进行研究，经分型，5例为确诊型急性重症胆道感染（ACST）（确诊型ACST组），85例为轻症胆道感染（轻症胆道感染组），10例为先兆型急性重型胆道感染（先兆型ACST组）。采用SPSS 15．0统计软件进行分析，组间比较采用单因素方差分析，数据经检验方差不齐，选择多个独立样本比较的Kruskal-Wallis H检验，以P＜0．05为差异有统计学意义。结果经治疗，仅有1例患者死亡，为确诊型胆囊炎穿孔患者。比较各组的术后残石率可得，确诊型ACST组（25．0％）和先兆型ACST组（20．0％）的术后残石率显著高于轻症胆道感染组（6．0％），差异有统计学意义（χ2＝5．16， P＜0．05）；但先兆型ACST组和确诊型ACST组之间进行比较，无显著差异（P＞0．05）。三组患者之中，确诊型ACST组患者术后的住院天数、术后住ICU天数最长，显著长于其他两组（t＝11．12， t＝3．85， P＜0．05）。术后随访3～6个月，患者进行影像学检查，所有患者均未出现复发。结论临床治疗胆道结石合并胆道感染患者的时候，若患者无禁忌证，则需要对先兆型急性重型胆道感染患者进行诊断和治疗，轻症者予以彻底手术治疗，先兆型急性重型者按照实际情况给予及时的手术治疗。
목적：탐토담도결석병담도감염적림상분형급수술시궤。방법종2011년5월지2013년5월수치적담도결석병담도감염환자중수궤선택100례진행연구，경분형，5례위학진형급성중증담도감염（ACST）（학진형ACST조），85례위경증담도감염（경증담도감염조），10례위선조형급성중형담도감염（선조형ACST조）。채용SPSS 15．0통계연건진행분석，조간비교채용단인소방차분석，수거경검험방차불제，선택다개독립양본비교적Kruskal-Wallis H검험，이P＜0．05위차이유통계학의의。결과경치료，부유1례환자사망，위학진형담낭염천공환자。비교각조적술후잔석솔가득，학진형ACST조（25．0％）화선조형ACST조（20．0％）적술후잔석솔현저고우경증담도감염조（6．0％），차이유통계학의의（χ2＝5．16， P＜0．05）；단선조형ACST조화학진형ACST조지간진행비교，무현저차이（P＞0．05）。삼조환자지중，학진형ACST조환자술후적주원천수、술후주ICU천수최장，현저장우기타량조（t＝11．12， t＝3．85， P＜0．05）。술후수방3～6개월，환자진행영상학검사，소유환자균미출현복발。결론림상치료담도결석합병담도감염환자적시후，약환자무금기증，칙수요대선조형급성중형담도감염환자진행진단화치료，경증자여이철저수술치료，선조형급성중형자안조실제정황급여급시적수술치료。
Objective To explore the operative time and clinical classification of biliary calculi accompanied with infection .Methods 100 patients with biliary calculi and infection were treated in our hospital from May 2011 to May 2013.There were 85 patients with mild biliary tract infection ( Mild biliary infection group) , 10 patients with threatened acute severe biliary tract infection ( threatened ACST group ) , and 5 patients with acute severe biliary tract infection ( diagnosed ACST group ) .The data were analyzed by using SPSS 15.0 statistical software, including single factor analysis of variance and the Kruskal Wallis H test.A P value <0.05 was considered statistically significant .Results There was one death,due to acute severe biliary infection with cholecystitis perforation .In comparison, the rates of postoperative residual stones in the ACST group(25.0%) and the threatened ACST group (20.0%) were significantly higher than that of the mild biliary infection group (6.0%) (χ2 =5.16, P<0.05).However, there was no significant difference between the ACST group and threatened ACST group (P>0.05).Hospital stay and postoperative ICU stay in the ACST group were the longest among the three groups (t=11.12, t=3.85, P<0.05).The patients were followed up for 3-6 months, and imaging examination showed no recurrence .Conclusions In the treatment of biliary calculi accompanied with infection , patients with threatened acute severe biliary tract infection should be diagnosed if there are no contraindications and therapeutic strategy of surgical treatments should be carried out timely according to actual situation .