| Background and Objective:Acute obstructive suppurative cholangitis (AOSC) is one of acute abdomen in general surgery. Being its sudden onset, rapid progression, severe illness and high mortality, it has been the most severe bilary tract infection and the leading cause of death in the benign biliary tract disease. Most of these patients are secondary to bile duct stones and a few are secondary to malignant tumor of biliary tract, biliary ascariasis, benign biliary strictures or sclerosing cholangitis and etc. Studys demonstrated that the mortality of AOSC was as high as 25%-50%. Although the incidence of this disease had been decreased to some extend since the 20th century 80 years, but Its mortality rate still remains the highest in benign biliary tract disease. In this study, we retrospectively analyzed the data of 51 patients with AOSC who were admitted to our hospital from January 2005 to December 2009. They had been treated with different therapies and achieved good effects.Moreover,16 clinical parameters of the case group were statistically analyzed in order to further explore the factors that affect the AOSC treatment efficacy and Intended to further guide the treatment.Method:16 variables from 51 consecutive patients with AOSC admitted to the First Affiliated Hospital of Shantou University Medical College from the past five years were included for statistical analysis. These variables include age, past history of whether biliary tract disease or biliary-tract surgery, past history of whether underlying disease, pathogen, AOSC stages, Preoperative ASA classification, whether surgical treatment, surgery option, duration of preoperative jaundice, preoperative serum bilirubin level, maximum temperature, preoperative white blood cell count, serum urea nitrogen, serum creatinine, clotting time and serum albumin. The mortality, survival rate, complication rate were taken as statistical indicators for staticical analysis to compare the clinical effectiveness of various factors on acute obstructive suppurative cholangitis.Results:(1) Among the patients included in this study,44 patients had received surgical treatment, in which 40 cases survived, while the rest 4 died; Among the 7 patients who did not received surgical treatment, only 2 cases survived and the remaining 5 cases were dead. Significant differences in mortality were noted between the surgery group and non-surgery group (P<0.01).(2) In the AOSC stage I group,35 patients received surgical treatment. Among them 20 patients took control operation, in which 1 patient died and 10 developed complications. The rest 15 patients took definitive operation in which 5 developed complications and no death be reported. No significant difference was noted in mortality survival and complication rates between control operation group and definitive operation group (P>0.05). As for the rate of residual stone, there were significant differences between the above two groups amonge all the cases.(P<0.05).(3) Insignificant differences were noted in the in mortality survival and complication rates (P>0.05) between underlying disease group and non-underlying disease group.Insignificant differences were noted in the in mortality and survival rates(P >0.05) while significant differences were noted in the in complication rates(P< 0.01) between past history of biliary tract disease or biliary-tract surgery groups and no particular previous medical history group.(4) Comparison of AOSC stages:There were significant differences between stageâ… group and stage +â…¢+â…£group in mortality survival and complication rates (P<0.01). significant differences were also noted in survival and mortality rates between stageâ…¡+â…¢group and stageâ…£group(p<0.01).Comparison of ASA classification:There were significant differences between ASA gradeâ… +â…¡group and ASA gradeâ…¢+â…£+â…¤group in mortality,survival and complication rates (P<0.05).(5) Measurement factor analysis:Compared with the survival group, the death group was older, had shorter hospitalization days, higher maximum temperature, preoperative white blood cell count, preoperative serum bilirubin level, serum urea nitrogen and serum creatinine, lower serum albumin, longer duration of preoperative jaundice and clotting time. The differences of the above factors between these two groups were significant.Compared with non-complication group, the complication group was older, had higher maximum temperature, preoperative white blood cell count, preoperative serum bilirubin level, serum urea nitrogen and serum creatinine, longer duration of preoperative jaundice and clotting time. T he differences of the above factors between these two groups were significant.Conclusions:(1) Reasonable and effective surgical treatment is crucial in improvingt the prognosis and survival rate of AOSC, the fundamental treatment should be Solving the obstruction and unobstructed drainage.(2) Advanced age, underlying diseases and history of a bile duct or bile duct surgery are not contraindications for surgery of this disease, but higher requirements are needed for surgery and Perioperative management.(3) Surgical decision-making should took ASA classification and AOSC stage as an important reference:surgical treatment should be taken when in ASA stageâ… or stageâ…¡;the treatment of choice in stageâ… of AOSC is common definive surgery; while for patients in stageâ…¡+â…¢+â…£, control surgery is superior to definive surgery in decreasing the complication and mortality.(4)Age, maximum temperature, preoperative white blood cell count, duration of preoperative jaundice.preoperative serum bilirubin level, serum urea nitrogen,serum creatinine and clotting time are correlated with the prognosis. Attaching importance to the ealry diagnosis and treatment of jaundice, popularizing relavant knowledge of AOSC and other obstructive bile duct diseases and improving the medical condition in the depressed area and poor population are fundamental measures to improving the clinical effectiveness. Early diagnosis and treatment are important sections in improving the effectiveness and decreasing the mortality of AOSC. |
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